World neurosurgery最新文献

{"title":"Posterior clinoidectomy in the subtemporal trans-tentorial approach for a basilar bifurcation aneurysm: technical note.","authors":"Yuki Hirose, Hideyuki Yoshioka, Koji Hashimoto, Takuma Wakai, Toru Tateoka, Norito Fukuda, Ryo Horiuchi, Takashi Yagi, Hiroyuki Kinouchi","doi":"10.1016/j.wneu.2025.123894","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123894","url":null,"abstract":"<p><strong>Objective: </strong>Although the endovascular approach has emerged as the first-choice treatment for basilar bifurcation aneurysms these days, there are situations where direct surgery remains necessary. Among several surgical approaches, the subtemporal trans-tentorial approach can be adapted for low-positioned aneurysms projecting posteriorly. Since surgeons observe the aneurysm from a lateral perspective in this approach, the posterior clinoid process (PCP) does not usually obstruct the surgical field, and posterior clinoidectomy in this approach has not been reported to date. We present the first report on the utility of posterior clinoidectomy to expand the surgical field of the subtemporal approach in a case involving a low-positioned basilar bifurcation aneurysm where a posterior petroclinoid ligament (PPL) obstructed the operative field.</p><p><strong>Methods: </strong>A 42-year-old female patient underwent neck clipping by the right subtemporal trans-tentorial approach for subarachnoid hemorrhage (SAH) due to a ruptured low-positioned basilar bifurcation aneurysm. In this case, despite incision of the tentorium posterior to the entrance of the right trochlear nerve, the PPL hindered the procedure. Posterior clinoidectomy using an ultrasonic aspirator with downward transition of the PPL successfully expanded the surgical field, enabling safe aneurysmal neck clipping.</p><p><strong>Results: </strong>The patient was discharged from our hospital without any neurological deficits.</p><p><strong>Conclusions: </strong>Even when using the subtemporal approach, the PPL could impede adequate aneurysmal exposure. Posterior clinoidectomy with downward PPL transition is an effective strategy in such cases.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123894"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639891","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":"Analysis of Long Noncoding RNA in Fatty Acid Metabolism to Identify Prognostic Markers and Predict Immunotherapy Response in Low-Grade Glioma","authors":"Yang Cui","doi":"10.1016/j.wneu.2025.123723","DOIUrl":"10.1016/j.wneu.2025.123723","url":null,"abstract":"<div><h3>Background</h3><div>Low-grade gliomas (LGGs) are notorious for their difficult early-stage diagnosis, limited treatment options, and poor prognosis, making them a focal point in cancer research. Long noncoding RNAs (lncRNAs) have been identified as regulators of metabolic reprogramming in tumor cells, offering new directions for LGG treatment.</div></div><div><h3>Methods</h3><div>This study employed data from The Cancer Genome Atlas, focusing on key fatty acid metabolism-related lncRNA. A risk scoring model was developed using univariate/multifactorial and least absolute shrinkage and selection operator Cox regression. Additionally, the study evaluated the role of these prognostic lncRNAs in LGG progression by assessing associations between LGG immune markers and tumor drug resistance. Finally, functional enrichment analysis highlighted the molecular roles of these lncRNAs.</div></div><div><h3>Results</h3><div>In this study, a total of 14 prognostic lncRNAs were obtained. The risk model demonstrated excellent validity and reliability, making it a superior predictor of prognosis among patients with varying LGG risks. Among the identified lncRNAs, GHET-1 was notably associated with LGG sensitivity to current chemotherapy options and might be a crucial lncRNA affecting LGG progression. High-risk patients exhibited T-helper cell-mediated immunosuppression, potentially paving new paths for future LGG immunotherapy.</div></div><div><h3>Conclusions</h3><div>Focusing on lncRNA regulation and fatty acid metabolism reprogramming, this study established an innovative prognostic prediction model for LGGs, showing outstanding validity and reliability. The findings offer new molecular and cellular targets for the future development of LGG treatments.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123723"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426437","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":"Are Mildly Disabled Patients Appropriate for Spine Bundles? An Application of the Operative Value Index","authors":"Advith Sarikonda ,&nbsp;Ashmal Sami ,&nbsp;D. Mitchell Self ,&nbsp;Emily Isch ,&nbsp;Alexander Zavitsanos ,&nbsp;Anthony A. Fuleihan ,&nbsp;Ayra Khan ,&nbsp;Conor Dougherty ,&nbsp;Danyal Quraishi ,&nbsp;Jack Jallo ,&nbsp;Joshua Heller ,&nbsp;Srinivas K. Prasad ,&nbsp;Ashwini Sharan ,&nbsp;James Harrop ,&nbsp;Alexander R. Vaccaro ,&nbsp;Ahilan Sivaganesan","doi":"10.1016/j.wneu.2025.123797","DOIUrl":"10.1016/j.wneu.2025.123797","url":null,"abstract":"<div><h3>Background</h3><div>Many studies have evaluated the effect of preoperative disability status on functional outcomes following spine surgery. However, no research has compared the “value” (outcomes per dollar spent) of surgery for patients with different levels of diagnosis-specific disability.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 429 patients who underwent neurosurgical anterior cervical discectomy and fusion. Time-driven activity-based costing was used to calculate total intraoperative costs. Neck Disability Index (NDI) scores were recorded at baseline and 3 months postsurgery. Patients were categorized into groups based on their preoperative NDI score. Our primary outcome was a novel Operative Value Index (OVI), defined as the percent change in NDI per $1000 spent intraoperatively. Generalized linear mixed model regression was used to determine if severe-to-complete (“high”) baseline neck disability was significantly associated with OVI and total cost.</div></div><div><h3>Results</h3><div>Compared to patients with “high” preoperative neck disability, the OVI was significantly lower for patients with no neck disability (β-coefficient: −14.0; <em>P</em> &lt; 0.001) and mild neck disability (β-coefficient: −4.06; <em>P</em> &lt; 0.001). There were no significant associations between the NDI groups and total intraoperative cost.</div></div><div><h3>Conclusions</h3><div>Surgery provided the most value for patients with “high” baseline neck disability, with more favorable outcomes per dollar spent compared to those with low baseline neck disability. Patients with low baseline neck disability may therefore be suboptimal candidates for bundled payments, emphasizing the importance of careful patient selection to optimize resource use and outcomes in value-based care models.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123797"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473114","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":"Reproduction of Original Glioblastoma and Brain Metastasis Research Findings Using Synthetic Data","authors":"William Davalan ,&nbsp;Roy Khalaf ,&nbsp;Roberto Jose Diaz","doi":"10.1016/j.wneu.2025.123808","DOIUrl":"10.1016/j.wneu.2025.123808","url":null,"abstract":"<div><h3>Objective</h3><div>Synthetic data (SD) is artificially generated information that mimics the statistical characteristics and correlations of real-world data, enabling researchers to simulate variables that are challenging to obtain in routine practice while overcoming confidentiality barriers. This study aims to evaluate the utility, validity, and potential limitations of SD in glioblastoma (GBM) and brain metastases (BM) research.</div></div><div><h3>Methods</h3><div>Three published neuro-oncology studies focusing on prognostic factors were selected: 2 involving GBM patients and 1 with BM patients. These studies were replicated using the <em>MDClone</em> platform, a healthcare data exploration tool that enables the creation of SD. Real-world data and SD were compared across patient demographic and outcome variables using summary statistics, normality testing, and <em>t</em>-test as required.</div></div><div><h3>Results</h3><div>452 GBM patients and 1320 BM patients were generated with SD. Among GBM patients, longer median overall survival was associated with younger age (age&lt;50: 16.3 months [95% CI: 12.8–19.8]; age 50–59: 15.6 [95% CI: 13.1–18.1]; age 60–69: 13.9 [95% CI: 12.1–15.7]; age&gt;70: 8.8 [95% CI: 7.4–10.2], <em>P</em> &lt; 0.001), greater extent of resection (debulking: 16.8 months [95% CI 14.9–18.7] vs. biopsy: 10.9 months [95% CI: 9.6–12.3], <em>P</em> &lt; 0.001), and higher serum albumin (sAlb) (sAlb&lt;30 g/L: 7.0 months [95% CI: 4.8–9.3]; sAlb 30–40 g/L: 12.9 [95% CI: 11.6–14.1]; sAlb&gt;40: 16.2 [95% CI: 13.4–19.1], <em>P</em> &lt; 0.05). Among BM patients, lower systemic inflammation scores (neutrophil-lymphocyte-ratio, leukocyte-lymphocyte-ratio, platelet-lymphocyte-ratio, monocyte-lymphocyte-ratio, and C-reactive-protein/albumin-ratio) were associated with longer overall survival (<em>P</em> &lt; 0.05). These results aligned with the findings reported in the literature.</div></div><div><h3>Conclusions</h3><div>Integrating SD into clinical research offers potential for providing accurate predictive insights without compromising patient privacy.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123808"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472586","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":"Causal Relationship Between Mitochondrial DNA Copy Number and Intervertebral Disc Degeneration: A Bidirectional 2-Sample Mendelian Randomization Study","authors":"Chengjie Ma,&nbsp;Junhua Fang,&nbsp;Rui Xu,&nbsp;Langtao Ma,&nbsp;Guiqian Zhang,&nbsp;Xionggang Yang,&nbsp;Zhi Peng,&nbsp;Sheng Lu","doi":"10.1016/j.wneu.2025.123732","DOIUrl":"10.1016/j.wneu.2025.123732","url":null,"abstract":"<div><h3>Objective</h3><div>The causal relationship between mitochondrial DNA copy number (mtDNA-CN) and intervertebral disc degeneration (IVDD) remains unclear. The study aimed to investigate the causal relationship between mtDNA-CN and IVDD using Mendelian randomization (MR) analyses.</div></div><div><h3>Methods</h3><div>The causal relationship between mtDNA-CN and IVDD was estimated using a bidirectional 2-sample MR method. The inverse-variance weighted method was employed as the main MR method. Sensitivity analyses were conducted to validate the robustness and reliability of the MR results.</div></div><div><h3>Results</h3><div>The MR results by inverse-variance weighted revealed that genetically predicted mtDNA-CN was not associated with IVDD (odds ratio = 0.91; 95% confidence interval = 0.79–1.04; <em>P</em> = 0.1731). Similar results were observed in other 4 MR methods (<em>P</em> &gt; 0.05). Heterogeneity was found in the analysis of IVDD on mtDNA-CN (<em>P</em> &lt; 0.05), while no horizontal pleiotropy was observed (<em>P</em> &gt; 0.05). Furthermore, the leave-one-out analysis indicated the robustness of MR results not biased by a single nucleotide polymorphism. Moreover, the reverse MR analysis did not reveal any significant causal association of IVDD on mtDNA-CN.</div></div><div><h3>Conclusions</h3><div>The study revealed that there is no causal relationship of mtDNA-CN on the risk of IVDD, nor does IVDD have a significant causal effect on mtDNA-CN. Although the study did not find a significant causal relationship, it provides valuable insights into the complex interplay between genetic factors and IVDD. Further research is needed to explore to better understand the underlying mechanisms of this condition.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415270","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":"Ischemic Stroke May Increase the Risk of Crohn's Disease and Ulcerative Colitis: Evidence from a Bidirectional Mendelian Randomization Study","authors":"Xin Luo,&nbsp;Liping Yao,&nbsp;Yinchao Chen,&nbsp;Yanju Song","doi":"10.1016/j.wneu.2025.123718","DOIUrl":"10.1016/j.wneu.2025.123718","url":null,"abstract":"<div><h3>Background</h3><div>The bidirectional causal relationship between ischemic stroke (IS) and inflammatory bowel disease (IBD) remains unclear, prompting us to propose a bidirectional Mendelian randomization (MR) study to investigate this relationship further.</div></div><div><h3>Methods</h3><div>We obtained IS data from the MEGASTROKE consortium and IBD data, including its subtypes ulcerative colitis (UC) and Crohn's disease (CD), from the International Inflammatory Bowel Disease Genetics Consortium. In this study, we utilized IBD and its subtypes as exposure variables and IS as the outcome variable, and vice versa, to explore the bidirectional relationship between them. We used the IBD genetic data from the FinnGen database as replication data to further explore the causality. In this study, we employed the inverse variance weighting method as our primary approach. For sensitivity analyses, we utilized additional methods including MR-Egger regression, weighted median estimation, MR pleiotropy residual sum and outlier (MR-PRESSO), and MR-Robust adjusted profile score. Furthermore, we conducted a random effects meta-analysis to combine the causal relationships derived from both the International Inflammatory Bowel Disease Genetics Consortium and FinnGen datasets, aiming to ascertain more robust causal associations.</div></div><div><h3>Results</h3><div>The initial phase of the bidirectional MR study revealed a causal relationship between IS and the risk of CD (odds ratio [OR] = 1.56, 95% confidence interval [CI]: 1.20–2.02, <em>P</em> = 0.0008) and UC (OR = 1.33, 95% CI: 1.05–1.69, <em>P</em> = 0.0179), but did not find a causal relationship between IBD as a whole and the risk of IS, nor between IBD subtypes and the risk of IS. During the replication phase, the FinnGen database did not reveal any significant correlation between IS and the risk of IBD, including its subtypes CD and UC. However, additional meta-analysis of the combined data from both databases indicated that IS is significantly associated with an increased risk of CD (OR inverse-variance weighted _(IVW) = 1.38, 95% CI: 1.07–1.69, <em>P</em> &lt; 0.05) and UC (OR_IVW = 1.27, 95% CI: 1.04–1.50, <em>P</em> &lt; 0.05), but not with the overall risk of IBD (OR_IVW = 1.05, 95% CI: 0.87–1.16, <em>P</em> &gt; 0.05). No significant effects were observed between IBD and IS risk, nor were there significant effects between IS and the risks of IBD, CD, or UC. To ensure the robustness of these findings, heterogeneity and pleiotropy tests were conducted.</div></div><div><h3>Conclusions</h3><div>IBD and its subtypes were not found to be causally associated with the risk of IS, whereas IS was found to be causally associated with the risk of CD and UC. This suggests that the risks of CD and UC should be closely monitored in patients with IS.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143391739","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":"Simple Reconstruction Method of Dural Defects for Minimal Anterior and Posterior Combined Transpetrosal Approach","authors":"Fajar Herbowo Niantiarno ,&nbsp;Hiroki Morisako ,&nbsp;Atsufumi Nagahama ,&nbsp;Masaki Ikegami ,&nbsp;Takeo Goto","doi":"10.1016/j.wneu.2025.123795","DOIUrl":"10.1016/j.wneu.2025.123795","url":null,"abstract":"<div><h3>Background</h3><div>The minimal anterior posterior combined (MAPC) transpetrosal approach is a valuable technique for accessing petroclival lesions with supra-infratentorial extensions. However, dural reconstruction following this approach presents significant challenges owing to subtemporal and presigmoid dural and transtentorial incisions, dural shrinkage resulting from coagulation, and spatial constraints.</div></div><div><h3>Methods</h3><div>This study retrospectively examined 25 patients who underwent MAPC transpetrosal approach between 2022 and 2024. We employed a simplified method of dural reconstruction using a fat graft and a sternocleidomastoid muscle-periosteum-temporal fascia flap without suturing. An absorbable polyglycolic acid material was fixed along the flap using fibrin glue to reinforce the sealing of the dura (question number 4, reviewer #1). The evaluation was conducted with a focus on subcutaneous cerebrospinal fluid (S-CSF) collection based on postoperative magnetic resonance imaging findings, and the strategies employed to address this complication were assessed.</div></div><div><h3>Results</h3><div>Of the 25 cases examined, 16 showed no evidence of S-CSF accumulation (grade 0). Two patients were classified as grade 1, while 7 patients exhibited grade 2 S-CSF collection. None of the patients experienced cerebrospinal fluid (CSF) leakage through the surgical incision nor did they develop CSF rhinorrhea or otorrhea. All instances of S-CSF accumulation resolved spontaneously within 2–6 weeks, without requiring surgical intervention. Only 1 patient with a history of repeat surgery required CSF diversion via a lumbar drain postoperatively.</div></div><div><h3>Conclusions</h3><div>The simple dural reconstruction method using autologous fat graft and sternocleidomastoid temporal fascia flap demonstrated promising results in terms of preventing CSF-related complications following the MAPC transpetrosal approach.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123795"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426172","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":"Volume of Operative Maneuverability as a New Measurement in Neuroanatomical Research: A Methodological Quantitative Study and Translational Use in the Operating Room","authors":"Leonardo Tariciotti ,&nbsp;Alejandra Rodas ,&nbsp;Biren Patel ,&nbsp;Youssef M. Zohdy ,&nbsp;J. Manuel Revuelta Barbero ,&nbsp;Erion Jr De Andrade ,&nbsp;Jackson Vuncannon ,&nbsp;Megan Cosgrove ,&nbsp;Roberto Soriano ,&nbsp;Edoardo Porto ,&nbsp;Justin Maldonado ,&nbsp;Samir Lohana ,&nbsp;C. Arturo Solares ,&nbsp;Francesco DiMeco ,&nbsp;Tomas Garzon-Muvdi ,&nbsp;Gustavo Pradilla","doi":"10.1016/j.wneu.2025.123761","DOIUrl":"10.1016/j.wneu.2025.123761","url":null,"abstract":"<div><h3>Objective</h3><div>The lack of standardized metrics in neuroanatomical research limits the objective assessment of neurosurgical approaches. We introduce a novel volume-based parameter, the Volume of Operative Maneuverability (VOM), and evaluate its utility in quantifying surgical corridor dimensions.</div></div><div><h3>Methods</h3><div>Seven microscopic and endoscopic skull base approaches were performed on 4 embalmed latex-injected human cadaveric specimens. A spatial principal component analysis algorithm converted surgical entry and target areas into ellipses, allowing ellipsoidal-based VOM calculations. Corridor length (“target distance”) and a fixed 10 mm distance from the target (“standardized VOM” [sVOM]) were also measured. Feasibility and reproducibility were assessed using three-dimensional photogrammetry, preoperative imaging models, and a clinical case.</div></div><div><h3>Results</h3><div>Endoscopic endonasal and anterior transmaxillary approaches offered sufficient corridor volume and trajectory distance but created longer, narrower surgical corridors with lower sVOM than transcranial approaches. Conversely, pretemporal-orbitozygomatic and subtemporal corridors showed the highest VOM and sVOM. Illustrative examples confirmed consistent measurement in photogrammetry and preoperative imaging. A clinical case involving a right spheno-cavernous meningioma demonstrated a VOM of 2.328 cm³, sVOM of 0.615 cm³, and a target distance of 18 mm during extradural anterior clinoidectomy.</div></div><div><h3>Conclusions</h3><div>VOM provides a quantitative, reproducible metric for assessing surgical maneuverability toward irregular target surfaces, overcoming the limitations of traditional qualitative assessments. Preliminary data support its use in quantitative neuroanatomical research and suggest potential integration into surgical planning and intraoperative data collection.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123761"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426306","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":"Genetically Proxied Antiplatelet Drug Target Perturbation and Risk of Aneurysmal Subarachnoid Hemorrhage: A Mendelian Randomization Analysis","authors":"Yu-xiang Fan ,&nbsp;Cheng-bin Yang ,&nbsp;Zi-hao Song ,&nbsp;Xu Yang ,&nbsp;Yong-jie Ma ,&nbsp;Hong-qi Zhang","doi":"10.1016/j.wneu.2025.123794","DOIUrl":"10.1016/j.wneu.2025.123794","url":null,"abstract":"<div><h3>Background</h3><div>The impact of antiplatelet drugs (APDs) on the rupture risk of unruptured intracranial aneurysms (uIAs) remains controversial. This study aimed to evaluate the causal effects of APDs on aneurysmal subarachnoid hemorrhage (aSAH) and uIA.</div></div><div><h3>Methods</h3><div>A two-sample Mendelian randomization (TSMR) analysis examined associations between genetically proxied platelet reactivity and aSAH. The therapeutic inhibition of platelet aggregation by 5 widely used APDs was proxied by expression quantitative trait loci from eqtlGen consortium and Genotype-Tissue Expression project v8 consortium and protein quantitative trait loci from deCODE database. Causal effects were estimated with summary-data-based MR, TSMR, colocalization analysis, and sensitivity analysis. Mediation MR analysis explored potential pathways.</div></div><div><h3>Results</h3><div>The platelet reactivity was inversely associated with the risk of aSAH, exhibiting no discernible heterogeneity or pleiotropic effects (odds ratio, 0.883; 95% confidential interval, 0.833–0.936; <em>P</em> = 2.67E-05). No causal effects on the aSAH and uIA were observed for the majority of APD target genes by summary-data-based MR, TSMR, and colocalization analysis. However, elevated genetic expression of platelet endothelial aggregation receptor 1 was associated with increased platelet reactivity with an odds ratio of 1.46 (β1<!--> <!-->=<!--> <!-->0.375, se=0.072; <em>P</em> = 1.99E-07), and this elevation showed significant inverse association with aSAH risks (β2<!--> <!-->=<!--> <!-->−0.125, se=0.030; <em>P</em> = 2.67E-05).</div></div><div><h3>Conclusions</h3><div>The platelet reactivity was inversely associated with aSAH risk. However, APDs were not identified as either risk or protective agents for aSAH or uIA. Targeting platelet endothelial aggregation receptor 1 might reduce platelet reactivity and increase aSAH risk, highlighting the need for further research.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123794"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433083","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":"Chronic, Shunt-Dependent Hydrocephalus in Aneurysmal Subarachnoid Hemorrhage: Incidence, Risk Factors, Clinical Phenotypes, and Outcome","authors":"Lydia Larsson ,&nbsp;Fredrik Vedung ,&nbsp;Johan Virhammar ,&nbsp;Elisabeth Ronne-Engström ,&nbsp;Anders Lewén ,&nbsp;Per Enblad ,&nbsp;Teodor Svedung Wettervik","doi":"10.1016/j.wneu.2025.123806","DOIUrl":"10.1016/j.wneu.2025.123806","url":null,"abstract":"<div><h3>Objective</h3><div>The main aim was to determine the incidence, risk factors, clinical phenotypes, and response to shunt surgery in chronic, shunt-dependent hydrocephalus (SDHC) after aneurysmal subarachnoid hemorrhage (aSAH).</div></div><div><h3>Methods</h3><div>In this observational, single-center study, 849 aSAH patients treated at Uppsala University Hospital between 2008–2018 were included. Variables on demography, injury severity, treatments, chronic hydrocephalus presentation, and outcome were evaluated.</div></div><div><h3>Results</h3><div>In total, 107 (13%) patients were treated with a shunt due to SDHC. In multivariate logistic regressions, risk factors for SDHC were worse neurologic (World Federation of Neurosurgical Societies) grade, larger ventricles (Evans index) at admission, the need to insert an external ventricular drain (EVD), decompressive craniectomy, and complications with meningitis. Six different SDHC phenotypes were identified: impeded neurological recovery (55%), Hakim-Adams syndrome (17%), high-pressure symptoms (13%), failed EVD removal (8%), external brain herniation after decompressive craniectomy (DC; 6%), and subdural hygroma (1%). The former 3 groups significantly improved in modified Rankin Scale (mRS) and 87%–100% exhibited subjective symptomatic relief. There was no significant change in mRS for the latter 3 groups, but 60%–100% experienced some subjective relief postoperatively.</div></div><div><h3>Conclusions</h3><div>Chronic SDHC was a common complication after aSAH, particularly in patients with severe primary brain injury, acute hydrocephalus, and treatment-related factors. The condition presents with distinct clinical phenotypes, which may influence treatment response. Recognizing these phenotypes could aid in optimizing patient selection and expectations for shunt surgery outcomes.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123806"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469193","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}