World neurosurgery最新文献

{"title":"Impact of Risk Factors and a New Transfer Pathway on Endovascular Thrombectomy Outcomes in Acute Ischemic Stroke","authors":"Chi-Ping Ting ,&nbsp;Dong-Yi Hsieh ,&nbsp;Hung-Sheng Lin ,&nbsp;Wen-Chan Chiu ,&nbsp;Yun-Ru Lai ,&nbsp;Fei-Shu Chang ,&nbsp;Shih-Wei Hsu ,&nbsp;Shih-Hsuan Chen ,&nbsp;Cheng-Hsien Lu","doi":"10.1016/j.wneu.2025.124458","DOIUrl":"10.1016/j.wneu.2025.124458","url":null,"abstract":"<div><h3>Objective</h3><div>Endovascular thrombectomy (EVT) is a time-critical therapy for acute ischemic stroke caused by large-vessel occlusion. To improve transfer efficiency, a web-based EVT transfer system was implemented in the Taiwan Stroke Network. This study evaluated its impact on workflow metrics and patient outcomes.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included AIS patients transferred for EVT between January 2021 and May 2024. Patients were categorized into traditional transfer pathway (TTP) or new transfer pathway (NTP) groups. Given the older age, longer onset-to-door time (ODT), and smaller sample size in the NTP group, propensity score matching (1:1, caliper = 0.1) was conducted using age and ODT.</div></div><div><h3>Results</h3><div>Among 356 patients (TTP: n = 293; NTP: n = 63), 63 matched pairs were analyzed. The NTP group had significantly shorter door-to-computed tomography angiography (12.2 ± 10.7 vs. 39.8 ± 33.8 minutes; <em>P</em> &lt; 0.0001) and door-to-groin puncture times (83.0 ± 24.4 vs. 109.2 ± 44.6 minutes; <em>P</em> &lt; 0.0001). These improvements were associated with better outcomes, including higher 1-month EQ-5D-5L visual analogue scale scores (61.6 ± 31.9 vs. 32.0 ± 30.9; <em>P</em> = 0.004), lower in-hospital mortality (11.1% vs. 31.7%; <em>P</em> = 0.009), and lower 3-month modified Rankin Scale scores (3.8 ± 1.7 vs. 4.6 ± 1.4; <em>P</em> = 0.004). Hypertension and National Institutes of Health Stroke Scale scores at 24–36 hours independently predicted poor functional outcomes.</div></div><div><h3>Conclusions</h3><div>The web-based EVT transfer system improved workflow and functional outcomes, highlighting its value even in a small referral cohort.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124458"},"PeriodicalIF":2.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024267","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 “Treatment of Pyogenic Ventriculitis with Retroauricular External Ventricular Drainage”","authors":"Arylic Singh,&nbsp;Katrina Shute","doi":"10.1016/j.wneu.2025.124455","DOIUrl":"10.1016/j.wneu.2025.124455","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124455"},"PeriodicalIF":2.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024235","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":"Endoscopic Transcortical Tubular-Based Resection of a Third Ventricle Colloid Cyst: Two-Dimensional Operative Video","authors":"Ilaria Bove,&nbsp;Jacopo Berardinelli,&nbsp;Teresa Somma,&nbsp;Domenico Solari,&nbsp;Felice Esposito,&nbsp;Luigi Maria Cavallo","doi":"10.1016/j.wneu.2025.124436","DOIUrl":"10.1016/j.wneu.2025.124436","url":null,"abstract":"<div><div>We present a case of third ventricle colloid cyst surgical resection using a tubular-based endoscopic transcortical approach. Third ventricle colloid are rare benign lesions typically found in the anterolateral part of the third ventricle, close to the foramen of Monro.<span><span>¹</span></span> Several surgical approaches have been employed for their management.<span><span>2</span></span>, <span><span>3</span></span>, <span><span>4</span></span> Tubular retractors have been introduced in the neurosurgical practice for their ability to minimize retraction-related injury by distributing retraction forces radially.<span><span>5</span></span>, <span><span>6</span></span>, <span><span>7</span></span> A 35-year-old male with a history of multiple sclerosis presented with severe headache and dizziness. Neuroimaging revealed the presence of left ventricular enlargement. Lesion exhibited a homogeneously high magnetic resonance imaging T2 weighted/T2 weighted fluid attenuated inversion recovery signal with and peripheral enhancement indicative of a colloid cyst. Colloid cyst localized in zone I of the Beaumont classification. A left small frontal craniotomy was performed. A 17-mm diameter ViewSite Brain Access System (Vycor Medical Inc., Boca Raton, Florida, USA) tubular retractor was guided into the left lateral ventricle under neuronavigation. Following controlled decompression of the mucinous content, the cyst capsule was progressively mobilized from critical neurovascular structures and removed. Free communication of the ventricular system was confirmed; therefore, no further maneuver was necessary. No postoperative complications were observed during the postoperative course. Postoperative magnetic resonance imaging on first month confirmed the gross total resection and resolution of hydrocephalus. The endoscopic transcortical tubular-based approach is an effective and safe method for treating colloid cysts. This approach offers the advantages of minimal invasiveness, optimal visualization, and reduced tissue manipulation, establishing a valid method in the management of colloid cysts in the third ventricle.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124436"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016262","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 Incidental Durotomy in Initial Posterior Decompression Surgery for Lumbar Central Canal Stenosis with Bilateral Neurogenic Claudication","authors":"Yudai Kumanomido ,&nbsp;Hideki Nakamoto ,&nbsp;Hiroyasu Kodama ,&nbsp;Michita Noma ,&nbsp;Hiroyuki Nakarai ,&nbsp;Junya Miyahara ,&nbsp;Koji Nakajima ,&nbsp;So Kato ,&nbsp;Yuki Taniguchi ,&nbsp;Naohiro Kawamura ,&nbsp;Akiro Higashikawa ,&nbsp;Yujiro Takeshita ,&nbsp;Masayoshi Fukushima ,&nbsp;Nobuhiro Hara ,&nbsp;Shima Hirai ,&nbsp;Hiroki Iwai ,&nbsp;Sakae Tanaka ,&nbsp;Yasushi Oshima","doi":"10.1016/j.wneu.2025.124453","DOIUrl":"10.1016/j.wneu.2025.124453","url":null,"abstract":"<div><h3>Objective</h3><div>To identify significant risk factors for incidental durotomy (ID) in initial posterior decompression surgery for lumbar central canal stenosis and to explore whether these risks vary by surgical approach through subgroup analyses.</div></div><div><h3>Methods</h3><div>This study included patients who underwent single-level posterior decompression surgery for lumbar central canal stenosis with bilateral neurogenic claudication at eight hospitals between April 2017 and May 2023. Patient demographics, comorbidities, and surgical details, including surgeon certification status, were collected. Statistical analyses included the chi-square test or Fisher exact test for categorical variables and Student <em>t</em> test for continuous variables. Multivariate binary logistic regression analysis was performed for the entire cohort and subgroups stratified by surgical approach.</div></div><div><h3>Results</h3><div>ID occurred in 6.3% (95/1512) of cases. For the entire cohort, both univariate and multivariate analyses identified female sex, oral anticoagulant/antiplatelet use, and oral steroid use as significant risk factors. However, the independent risk factors for ID differed by surgical approach. In conventional open laminectomy, multivariate analysis identified oral anticoagulant/antiplatelet use (odds ratio [OR] 3.0, 95% confidence interval [CI]: 1.15–7.67) and oral steroid use (OR 5.8, 95% CI: 1.38–24.8) as significant risk factors. In contrast, in microendoscopic surgery, female sex (OR 2.0, 95% CI: 1.19–3.47) was a significant risk factor, while surgery performed by a certified instructor was protective (OR 0.46, 95% CI: 0.29–0.82).</div></div><div><h3>Conclusions</h3><div>Risk factors for ID are dependent on surgical approach. For open procedures, pharmacological factors are paramount, while for microendoscopic procedures, female sex and surgeon experience are critical. Preventive strategies should be tailored to the surgical method.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124453"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016290","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":"Impact of Subdural Drain Omission on Recurrence After Chronic Subdural Hematoma Surgery: A Retrospective Study","authors":"Kento Tsuburaya ,&nbsp;Kimiyuki Kawaguchi ,&nbsp;Takashi Matsumori ,&nbsp;Masashi Uchida ,&nbsp;Yuichiro Kushiro ,&nbsp;Gaku Hidaka ,&nbsp;Hiroshi Takasuna ,&nbsp;Hidemichi Itoh ,&nbsp;Ichiro Takumi ,&nbsp;Toshihiro Ueda ,&nbsp;Hidetoshi Murata","doi":"10.1016/j.wneu.2025.124431","DOIUrl":"10.1016/j.wneu.2025.124431","url":null,"abstract":"<div><h3>Objective (Background)</h3><div>Although subdural drain (SDD) placement reduces recurrence after burr-hole surgery for chronic subdural hematoma, complications have led our institution to discontinue its routine use. During the first year following this change, the recurrence rate was 14.6%, comparable to the recurrence rate observed prior to discontinuation.</div></div><div><h3>Methods</h3><div>We retrospectively compared 150 cases with SDD (SDD+ group) and 129 recent cases without SDD (SDD-group). Patient characteristics, recurrence rates, complications, operative time, hospital stay, and costs were analyzed.</div></div><div><h3>Results</h3><div>Recurrence occurred in 13.9% of the SDD+ group and 8.0% of the SDD-group (<em>P</em> = 0.119). Post-hoc analysis revealed low statistical power (34.1%), suggesting a risk of Type II error. The SDD-group had significantly shorter operative time (40.9 vs. 54.9 minutes) and hospital stay (6.0 vs. 11.8 days), with a cost reduction of $811.8 per case. Complication rates were similar (4% vs. 1%), but 3 serious SDD-related complications were noted in the SDD+ group. Multivariate analysis identified preoperative hematoma thickness and postoperative subdural thickness as independent recurrence factors, while SDD use was not.</div></div><div><h3>Conclusions</h3><div>Omitting SDD placement did not significantly increase recurrence but was associated with shorter operative times, reduced hospital stays and costs, and fewer serious complications. While the study may be underpowered to definitively rule out a difference in recurrence, these findings support the feasibility of omitting SDD in initial surgeries. Future randomized controlled trials are warranted to confirm these results.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124431"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016228","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":"Incidence of Spinal Epidural Hematoma After Anterior Cervical Decompression and Fusion: Systematic Review, Meta-Analysis, and Case Report","authors":"Jerzy Gregorczyk ,&nbsp;Negin Fani ,&nbsp;Mikołaj Biegański ,&nbsp;Jakub Mocarski ,&nbsp;Pawel Kowalczyk ,&nbsp;Piotr Dąbrowski ,&nbsp;Rafał Górski ,&nbsp;Mateusz Bielecki","doi":"10.1016/j.wneu.2025.124442","DOIUrl":"10.1016/j.wneu.2025.124442","url":null,"abstract":"<div><h3>Introduction</h3><div>Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure used to treat herniated discs, degenerative disc disease, and nerve root compression in the cervical spine. This systematic literature review aims to analyze the available literature on the incidence, risk factors, clinical considerations, and available therapies for spinal epidural hematoma (SEH) following ACDF.</div></div><div><h3>Methods</h3><div>A systematic search was conducted in PubMed, Google Scholar, and Embase from database inception to June 18, 2025, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The search yielded 71 studies without duplicates. After applying the inclusion and exclusion criteria, 5 studies were selected for the final analysis.</div></div><div><h3>Results</h3><div>The overall incidence of SEH following ACDF was 0.835%. Most patients presented with dyspnea, paraplegia, or quadriplegia. A meta-analysis of the 5 studies (n = 3246; 28 events) confirmed this incidence, with moderate heterogeneity. Management varied on the basis of symptom severity, hematoma size, and neurological impairment. Surgical decompression was the most common treatment, although some cases were managed conservatively with success. SEH onset ranged from within 24 hours postoperatively to several days after surgery.</div></div><div><h3>Conclusions</h3><div>Although uncommon, SEH after ACDF carries significant clinical risks. Preventive measures may help mitigate its occurrence. However, the limited literature prevents a precise determination of the incidence and associated risk factors, including coagulation disorders. There is a clear need for large-scale prospective and retrospective studies with standardized reporting to more accurately define the incidence, identify risk factors, and determine the optimal management of SEH following ACDF.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124442"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016280","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":"Global Research Trends in Vertebral Artery Stenosis Treatment From 1980 to 2024: A Bibliometric and Visualized Analysis","authors":"Fei-Yi Yan,&nbsp;Yi-Bing Sun,&nbsp;Yu Lu","doi":"10.1016/j.wneu.2025.124440","DOIUrl":"10.1016/j.wneu.2025.124440","url":null,"abstract":"<div><h3>Objective</h3><div>The present study intends to conduct a comprehensive bibliometric analysis of the research pertaining to the treatment of vertebral artery stenosis (VAS), with the objective of elucidating the evolution and trends in therapeutic strategies.</div></div><div><h3>Methods</h3><div>A bibliometric analysis of publications spanning between January 1, 1980, and August 13, 2024, was conducted utilizing the Web of Science Core Collection database. The analysis and visualization of the data were performed using VOSviewer, CiteSpace, and R package “bibliometrix” software.</div></div><div><h3>Results</h3><div>The analysis included 856 documents published in 261 journals. The United States (202 publications, 23.60%), China (195 publications, 22.78%), and Japan (119 publications, 13.90%) were the leading countries in research output, with Capital Medical University identified as the most productive institution (63 publications). <em>Neurosurgery</em> and <em>Stroke</em> emerged as the most influential journals, exhibiting the highest H-index (both H-index = 8). Keyword clustering analysis revealed 4 distinct research domains: clinical trials and medical management; surgical interventions; endovascular techniques; and diagnostic approaches. The analysis revealed evolving research priorities in VAS treatment, highlighting “stents”, “angioplasty”, and “drug-coated balloon” as central themes. Keywords demonstrated a temporal evolution, with recent trends emphasizing “diagnosis”, “ischemic stroke”, and “endovascular treatment”.</div></div><div><h3>Conclusions</h3><div>The bibliometric analysis traces VAS treatment from surgical to advanced endovascular methods. Keyword clustering revealed 4 primary domains; burst analysis shows growing interest in drug-coated balloons and precision diagnostics. Future work should target novel endovascular devices, precise diagnostic criteria, and long-term outcomes. Clinically, emphasis is on minimally invasive interventions and integrating advanced imaging with personalized treatment strategies.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124440"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016231","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":"Lateral Lumbar Interbody Fusion (LLIF): Is Trans-Psoas Surgery Associated with Muscle Size Changes and Clinical Findings?","authors":"Luke L. Jouppi ,&nbsp;Clifford Pierre ,&nbsp;Neel T. Patel ,&nbsp;Julius Gerstmeyer ,&nbsp;Mark Kraemer ,&nbsp;Nicholas Minissale ,&nbsp;Colin Gold ,&nbsp;Cameron Hogsett ,&nbsp;Daniel C. Norvell ,&nbsp;Amir Abdul-Jabbar ,&nbsp;Jens R. Chapman ,&nbsp;Rod J. Oskouian","doi":"10.1016/j.wneu.2025.124437","DOIUrl":"10.1016/j.wneu.2025.124437","url":null,"abstract":"<div><h3>Objective</h3><div>Lateral lumbar interbody fusion (LLIF) is based on a less-invasive access corridor through the retroperitoneum and psoas muscle, though concerns persist over postoperative weakness and neuropathy on the surgical side. This study investigates if the trans-psoas LLIF approach is associated with long-term changes in psoas morphology, hip flexor weakness, and lower extremity dysesthesia.</div></div><div><h3>Methods</h3><div>The authors retrospectively reviewed all LLIF cases at a single institution from January 2016 to June 2024. Inclusion required the availability of preoperative and postoperative magnetic resonance imaging. Psoas cross-sectional area was measured at the L4 upper endplate and the level of surgery. Clinical outcomes were analyzed through standardized Oxford motor examinations, standardized sensory examinations, and patient-reported symptoms as documented and reviewed by the attending surgeon.</div></div><div><h3>Results</h3><div>Eight hundred sixty-five patients underwent LLIF, of which 108 patients met inclusion criteria for imaging and indication (48 male, 60 female). The mean follow-up for included patients was 2.8 years (range 3.8 months–7.3 years). We observed a statistically significant mean decrease of 6.3% in psoas size on the surgical side (<em>P</em> &lt; 0.001, Cohen's d = 0.19) and no significant change on the non-surgical side (<em>P</em> = 0.20, d = 0.07), both reflecting inconsequential effect sizes. Average hip flexor strength decreased by ≥ 1 grade in 8 (14.5%) patients on the surgical side and 5 patients (9.1%) on the nonsurgical side, with no significant difference between groups (<em>P</em> = 0.85).</div></div><div><h3>Conclusions</h3><div>Our study found that LLIF was associated with minor long-term decreases in psoas size and quality on the surgical side, small mean bilateral strength losses, and no side-specific sensory deficits.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124437"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016265","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":"Safety and Feasibility of Lumbar Cerebrospinal Fluid Drainage with Intrathecal Pressure Monitoring in Acute Severe Spinal Cord Injury: A Randomized Pilot Trial","authors":"Victoria Dembour ,&nbsp;Amani Beloauer ,&nbsp;Simon Diaz ,&nbsp;Benoit Maeder ,&nbsp;Marco Germann ,&nbsp;Dominique Rothenfluh ,&nbsp;Juan Barges-Coll","doi":"10.1016/j.wneu.2025.124441","DOIUrl":"10.1016/j.wneu.2025.124441","url":null,"abstract":"<div><h3>Background</h3><div>Spinal cord perfusion impairment is a critical secondary mechanism in acute spinal cord injury (SCI). Although lumbar cerebrospinal fluid (CSF) drainage is widely used in cardiothoracic surgery, its use in SCI remains limited. This study presents an evaluation of the safety and feasibility of lumbar CSF drainage with intrathecal pressure (ITP) and spinal cord perfusion pressure (SCPP) monitoring in acute SCI patients.</div></div><div><h3>Methods</h3><div>We conducted a prospective randomized pilot trial involving 21 patients with acute traumatic SCI (American Spinal Injury Association [ASIA] A–C). Twelve patients received continuous lumbar CSF drainage and SCPP monitoring over 72 hours, whereas 9 received standard care. The primary outcome measured was the change in ASIA scores at 12 months. The secondary outcomes included ITP measurements, mean arterial pressure requirements, and feasibility and safety data.</div></div><div><h3>Results</h3><div>The initial ITP in the drainage group averaged 15 mmHg and was reduced to 6 mmHg via controlled drainage. This group maintained lower mean arterial pressures (74 vs. 82 mmHg, <em>P</em> = 0.004) compared to the control group and required less vasopressor support. Neurologically, 4 patients in the drainage group improved to ASIA C or D, compared to 1 patient in the control group. The mean motor score improvement was greater in the drainage group (Δ11 vs. Δ7), although the difference was not statistically significant. No drainage-related complications occurred.</div></div><div><h3>Conclusions</h3><div>Lumbar CSF drainage is a safe and feasible intervention for the treatment of acute SCI, enabling tailored perfusion management. Although preliminary findings are promising, larger multicenter trials are needed to validate their clinical efficacy and define optimal SCPP targets.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124441"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016222","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":"Brainstem Cavernous Malformations: A Systematic Review and Meta-Analysis","authors":"Ali K. Al-Shalchy ,&nbsp;Rania H. Al-Taie ,&nbsp;Anmar H. Al-Rubaye ,&nbsp;Samip Patel ,&nbsp;Mostafa H. Algabri ,&nbsp;Mustafa Ismail","doi":"10.1016/j.wneu.2025.124452","DOIUrl":"10.1016/j.wneu.2025.124452","url":null,"abstract":"<div><h3>Background</h3><div>Brainstem cavernous malformations (BSCMs) are rare yet high-risk vascular lesions with a complex clinical course due to their eloquent location. Optimal treatment remains a topic of debate. This review aims to evaluate the outcomes of different management strategies for BSCMs, with a focus on rebleeding, functional recovery, and mortality.</div></div><div><h3>Methods</h3><div>Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, databases, including PubMed and Scopus, were searched. Data from 45 studies were analyzed using crude and pooled estimates. We used meta-regression to predict outcomes and adjust for heterogeneity. The risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions -I and Risk Of Bias In Non-randomized Studies of Interventions-II tools.</div></div><div><h3>Results</h3><div>This meta-analysis included 45 studies with 3070 patients: 1928 underwent surgery, 543 radiosurgeries, and 599 conservative treatments. Surgery had the lowest recurrence (1.1%), rebleeding (3.3%), retreatment (1.3%), and mortality (1.4%) rates. Radiosurgery showed moderate rates (recurrence 4.4%, rebleeding 7.0%, and retreatment 4.1%), while conservative management had the highest rebleeding (26.3%) and mortality (3.2%). Functional improvement (modified Rankin Scale [mRS]) was highest in the surgical group (60.2%) versus radiosurgery (28.3%) and conservative care (35.7%). Larger lesion size significantly predicted worse mRS improvement (<em>P</em> = 0.007) and higher mortality (<em>P</em> = 0.02), especially in radiosurgical patients.</div></div><div><h3>Conclusions</h3><div>Our findings largely reflect the cohort of hemorrhagic or symptomatic BSCMs for which microsurgical resection is generally associated with more favorable outcomes, including lower rates of recurrence, rebleeding, and mortality, when compared with radiosurgery and conservative care. Caution is warranted in extrapolating to incidental or asymptomatic lesions. Future research should also integrate advanced imaging and molecular approaches to refine risk stratification and guide management.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124452"},"PeriodicalIF":2.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016249","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}