World neurosurgery最新文献

{"title":"Comparative Efficacy of Three Methods of Lumbar Interbody Fusion for Lumbar Degenerative Diseases in a Tertiary Public Hospital.","authors":"Xiaofeng Yuan, Rui Tao, Mengfei Zhu, Jiajun Zhu","doi":"10.1016/j.wneu.2024.12.012","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.12.012","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy of large-channel endoscope-assisted posterior lumbar interbody fusion (Endo-PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open posterior lumbar interbody fusion in the treatment of degenerative diseases of the lumbar spine.</p><p><strong>Methods: </strong>The data of 110 patients with degenerative diseases of the lumbar spine were analyzed retrospectively: 31 cases had Endo-PLIF, 36 patients received MIS-TLIF, and 43 cases underwent modified-TLIF. We compared several parameters among the three groups: operative duration; intraoperative blood loss; latent blood loss; intraoperative radiation dose; visual analog scale (VAS) score; Oswestry Disability Index (ODI); anterior protrusion angle of the intervertebral space; postoperative ambulatory time; postoperative duration of hospital stay; complications. The prevalence of interbody fusion was observed at follow-up.</p><p><strong>Results: </strong>The operative duration of Endo-PLIF was longer than that of MIS-TLIF and modified-TLIF (P <0.05). In terms of intraoperative blood loss, latent blood loss, and recovery time, Endo-PLIF and MIS-TLIF had clear advantages (P <0.05). The VAS score and ODI of the three groups were satisfactory, but the low-back pain of patients in the Endo-PLIF group and MIS-TLIF group was less than that in the modified-TLIF group (P <0.05). In terms of complications and prevalence of interbody fusion, there were no significant differences among the three groups (P >0.05).</p><p><strong>Conclusion: </strong>All three operative methods had satisfactory efficacy. Endo-PLIF can be employed to treat lumbar degenerative diseases more precisely and in a minimally invasive fashion, but a learning curve and improvement in surgical instruments are needed.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802409","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":"A Review of Neurosurgical randomized controlled trials in the Cochrane Database of Systematic Reviews: Key Findings and Implications for Future Research.","authors":"Daniel Thompson, Adam Williams, Peter Hutchinson, Adel Helmy, David Cromwell","doi":"10.1016/j.wneu.2024.11.054","DOIUrl":"10.1016/j.wneu.2024.11.054","url":null,"abstract":"<p><strong>Objective: </strong>Evidence available to clinicians and patients to inform treatment decisions is ideally produced by randomized controlled trials (RCTs). The objective of this study was to assess the extent to which neurosurgical practice is supported by RCT-level evidence.</p><p><strong>Methods: </strong>A search of the Cochrane Library was conducted to find reviews of the effectiveness of neurosurgical operative interventions. Data were extracted on the intervention, patient population, and outcome measures as well as the strength of evidence, as rated by the Cochrane authors. The extracted data were analyzed to identify the gaps and areas of (in)consistency across the RCTs included within the Cochrane Reviews.</p><p><strong>Results: </strong>A total of 52 Cochrane Reviews met the inclusion criteria, which covered 8 neurosurgical subspecialties. However, only 28 were published after 2015. There was limited coverage of multiple commonly performed neurosurgical interventions and 9 reviews found no RCTs related to their selected topic. In 28 reviews, results were synthesized from 5 or fewer trials. Primary outcomes also varied among trials examining similar interventions. The overall quality rating of the evidence for the different subspecialties varied, with the majority of reviews rating the evidence as being from very low to low.</p><p><strong>Conclusions: </strong>The RCT-level evidence supporting neurosurgical practice is varied and the outcomes tested remain predominantly heterogeneous. There remain important neurosurgical conditions where treatment strategies are not underpinned by high-quality evidence. Pragmatic RCTs, well-designed observational studies as well as robust audit and registry processes may provide the real-world evidence for treatment decisions in neurosurgical care.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123471"},"PeriodicalIF":1.9,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693521","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":"Bibliometric Analysis of Myelomeningocele Management: National Disease Burden versus Publication Volume.","authors":"Belinda Shao, Alphadenti Harlyjoy, Olivia A Kozel, Megan Eh Still, Setyo Bp Widodo, Chibueze Agwu, Emilija Sagaityte, Christian Schroeder, Hannah E Gilder, Radzi Hamzah, Felicia W Sun, Joshua R Feler, Santos Santos, Kelsey Sawyer, Konstantina A Svokos, Petra M Klinge, Walter Johnson, Ronnie E Baticulon, Kee B Park","doi":"10.1016/j.wneu.2024.11.027","DOIUrl":"10.1016/j.wneu.2024.11.027","url":null,"abstract":"<p><strong>Background: </strong>Myelomeningocele (MMC) disproportionately affects low-resource areas and regions without mandatory folic acid fortification. No specific literature exists on the distribution of research output regarding neurosurgical management of myelomeningocele worldwide in relation to regional disease burden. We aimed to examine the country of origin and patient population of published papers on MMC and topics related to neurosurgical management of MMC, to determine whether these were proportionate to disease burden.</p><p><strong>Methods: </strong>A systematic literature search was conducted on neurosurgical aspects of MMC care. The geographic distribution of neurosurgical MMC research output was examined against the national burden of disease. Bibliometric analysis quantified author and patient country affiliations stratified by World Bank income group classification and folic acid fortification status, juxtaposed with disease burden.</p><p><strong>Results: </strong>From 9692 titles, 1843 were included, representing 107,446 patients and 2650 authorship instances. High-income countries (HICs) constituted 3% of 2019's global neural tube defect (NTD) births, 74% of authorships, and 83% of patients represented. Upper-middle-income countries (UMICs) represented 9% of NTD births, 16% of authorships, and 9% of published patients. Lower-middle-income countries (LMICs) represented 55% of NTD births but only 8.6% of authorships and 7% of patients. Low-income countries (LICs) shouldered 32% of NTD births and contributed 1.3% of authorships and 1.6% of patients. Countries with mandatory folic acid fortification represented 75% of patients and 54% of authorships. Postnatal repair, hydrocephalus, and postoperative complications were the most frequently studied topics.</p><p><strong>Conclusions: </strong>The global literature concerning neurosurgical management of myelomeningocele originates predominantly from HICs. Published experiences of myelomeningocele patients from LICs/LMICs are scarce, even though they constitute the majority of the affected population. Neurosurgeons and other health professionals must address this mismatch between disease burden and publication volume in order to inform practice, policy, and advocacy for MMC care worldwide.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123444"},"PeriodicalIF":1.9,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689062","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 Transorbital Approach to the Internal Carotid and Middle Cerebral Arteries. A Dissection Study Toward Targeted Access Aneurysm Clipping.","authors":"Alejandra Mosteiro, Roberto Manfrellotti, Ramon Torné, Dario Gagliano, Marta Codes, Doriam Perera, Alberto Di Somma, Alberto Prats-Galino, Joaquim Enseñat","doi":"10.1016/j.wneu.2024.11.069","DOIUrl":"10.1016/j.wneu.2024.11.069","url":null,"abstract":"<p><strong>Background: </strong>The application of the transorbital (TO) approach for vascular lesions has been scarcely explored. In this anatomic study, we examine the carotid and middle cerebral arteries from the TO perspective and investigate the feasibility of vascular clipping in a pseudovascularized model.</p><p><strong>Methods: </strong>Three fixed human cadaveric specimens (6 sides) were used for dissection. The sequential TO approach comprised 1) conventional lateral orbital craniectomy; 2) lateral orbital rim removal; and 3) anterior clinoidectomy. The clinoidal, ophthalmic, and communicating carotid segments, branches, related cranial nerves, and dural attachments were examined. Comparison among the 3 variations of bone removal determined the minimal necessary steps for each vascular segment. An additional fresh pseudovascularized specimen (2 sides) was used to test the surgical feasibility of clipping.</p><p><strong>Results: </strong>The TO approach allowed exposure of the carotid C4 to bifurcation. Clinoidectomy and dural ring opening exposed lateral and dorsal aspects of C5/C6 and the ophthalmic, but not medial or ventral aspects, nor the superior hypophyseal artery or the carotid cave. The posterior communicating artery could be followed from origin to end. The anterior choroidal origin was seen but disappeared behind the uncus. The carotid bifurcation was visible, M1 could be followed to its bifurcation, but A1 lay deep within the field. The corridor permitted arachnoidal dissection, vessel manipulation, and clipping of exposed segments.</p><p><strong>Conclusions: </strong>The TO approach provides anatomic access to the lateral and dorsal carotid siphon, complete posterior communicating artery, and proximal middle cerebral artery. This preliminary study suggests potential application in the elective treatment of paraclinoid and posterior communicating aneurysms.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123486"},"PeriodicalIF":1.9,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693404","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":"Non-invasive skin autofluorescence of advanced glycation end-products in patients with degenerative cervical myelopathy.","authors":"Toru Doi, Tomohisa Inoue, Jun Sugaya, Chiaki Horii, Keiichiro Tozawa, Hiroyuki Nakarai, Katsuyuki Sasaki, Yuichi Yoshida, Yusuke Ito, Nozomu Ohtomo, Ryuji Sakamoto, Koji Nakajima, Kosei Nagata, Naoki Okamoto, Hideki Nakamoto, So Kato, Yuki Taniguchi, Yoshitaka Matsubayashi, Sakae Tanaka, Ken Okazaki, Yasushi Oshima","doi":"10.1016/j.wneu.2024.12.015","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.12.015","url":null,"abstract":"<p><strong>Objective: </strong>To clarify the association between skin autofluorescence of advanced glycation end-products (AGEs) and clinical outcomes and pain in patients with degenerative cervical myelopathy (DCM).</p><p><strong>Methods: </strong>Consecutive patients with DCM were prospectively enrolled. AGEs assessed by skin autofluorescence (the AGE score) were examined at the middle fingertip in eligible patients. Patients were divided into lower AGE score (AGE-L) and higher AGE score (AGE-H) groups based on a cutoff AGE score of 0.54. Demographic data, laboratory data, maximum spinal cord compression (MSCC), clinical outcomes, such as Euro Quality of Life 5-Dimmension, Neck Disability Index, and Japanese Orthopaedic Association score, and Numerical Rating Scale (NRS) score for neck, arm, hand, leg, and foot pain were compared between the two groups. Multiple linear regression analysis was performed to assess the association between the AGE score and the NRS score for pain in the lower limbs.</p><p><strong>Results: </strong>Of the 263 patients, 93 were included in this study (41 with the AGE-L group and 52 with the AGE-H group). Demographic data, laboratory data, MSCC, and clinical outcomes were comparable between the two groups. The AGE-H group had significantly higher NRS scores for leg and foot pain than the AGE-L group. Multiple linear regression analysis revealed that higher AGE scores were significantly associated with more severe pain in the lower limbs in patients with DCM.</p><p><strong>Conclusions: </strong>Noninvasive skin autofluorescence of AGEs may be a useful biomarker for pain symptoms in the lower limbs in patients with DCM.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802346","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":"Diagnosis and Treatment of Cerebral Aneurysm Associated with Segmental Arterial Mediolysis: Our Experience and Systematic Review.","authors":"Fukutaro Ohgaki, Takashi Shuto, Shigeo Matsunaga, Nagatsuki Tomura, Jo Sasame, Kazuki Miyazaki, Kei Iwamoto, So Ozaki","doi":"10.1016/j.wneu.2024.11.053","DOIUrl":"10.1016/j.wneu.2024.11.053","url":null,"abstract":"<p><strong>Background: </strong>Segmental arterial mediolysis (SAM) is a nonatherosclerotic, noninflammatory vascular disease, initially reported in 1976 by Slavin and Gonzalez-Vitale. SAM-associated cerebral aneurysms have been reported in limited cases, and the disease entity is not fully understood. Therefore, we propose a diagnostic and treatment strategy with a systematic review of previously reported cases and our cases.</p><p><strong>Methods: </strong>We systematically searched cases of SAM-associated cerebral aneurysms using an online database. The findings of each included study and our cases were systematically reviewed in terms of characteristics, aneurysm, and clinical course.</p><p><strong>Results: </strong>In addition to our 2 cases, 41 cases from 32 publications were included. SAM-associated cerebral aneurysms were common among East Asians, particularly Japanese, aged 40-50 years, and typically presented as subarachnoid hemorrhage (SAH; 86%). Most aneurysms (75%) were dissection aneurysms. Subarachnoid hemorrhage (SAH) cases had a higher risk of successive intra-abdominal hemorrhage (IAH) caused by visceral aneurysm rupture (59%), with a mortality of 41%. It was most likely to occur 8.2 ± 7.3 days after SAH. If operations were accomplished, the prognosis was relatively good (modified Rankin Scale score 0-3; 71%).</p><p><strong>Conclusions: </strong>SAM-associated cerebral aneurysms can be life-threatening because of the risk of rupture and can lead to successive IAH after SAH. However, the prognosis is relatively good if an operation is successful. Therefore, precise diagnosis is required for suspected cases at first, and appropriate surgical treatment is required. Moreover, appropriate management of successive IAH is required among patients with SAH.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123470"},"PeriodicalIF":1.9,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693666","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":"Does Adjuvant Radiotherapy Enhance Survival in Intracranial Solitary Fibrous Tumor Patients?","authors":"Sakhr Alshwayyat, Haya Kamal, Tala Abdulsalam Alshwayyat, Mustafa Alshwayyat, Mesk Alkhatib, Ayah Erjan","doi":"10.1016/j.wneu.2024.12.004","DOIUrl":"https://doi.org/10.1016/j.wneu.2024.12.004","url":null,"abstract":"<p><strong>Purpose: </strong>Intracranial solitary fibrous tumor (SFT) is a rare central nervous system (CNS) tumor that lacks a reliable prognostic clinical model. Uncertainty persists regarding the treatment outcomes of surgery and adjuvant radiotherapy (ART). To address this, we investigated the efficacy of ART and applied machine learning (ML) to develop accurate prognostic models.</p><p><strong>Methods: </strong>The SEER database was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five ML algorithms to predict 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of the models. We investigated the role of ART and surgery using Kaplan Meier survival analysis, competing risk analysis and BRACE method.</p><p><strong>Results: </strong>The study population comprised 747 patients. Among them are 316 patients with \"surgery\" and 431 patients with \"surgery + ART.\" The therapeutic groups showed significant differences in overall survival (OS). Multivariate Cox regression analysis revealed that older age and surgery alone were poor prognostic factors. The most significant prognostic factors were the local tumor excision, followed by lobectomy and age.</p><p><strong>Conclusion: </strong>Although ART did not lead to a substantial decrease in cancer-specific deaths, it did improve OS. This underscores the broader health benefits of ART, including effective management of comorbid conditions. Caution is advised when interpreting these survival benefits because of potential confounding factors in patient health and treatment management. Our web tool and ML models aid in clinical decision-making.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142795250","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":"Fractionated Radiotherapy With Stereotactic Radiosurgery Boost Controls Gross Disease in Grade 2 Meningioma.","authors":"Rebecca L Calafiore, Corbin A Helis, Paul Marcet, Eleanor Smith, Benjamin Ramsey, Heather Pacholke, Carol A Kittel, Marc Benayoun, James D Ververs, Christina K Cramer, Adrian W Laxton, Stephen B Tatter, Michael D Chan, Jaclyn J White","doi":"10.1016/j.wneu.2024.11.012","DOIUrl":"10.1016/j.wneu.2024.11.012","url":null,"abstract":"<p><strong>Objective: </strong>Opportunity exists for improved local control rates of grade 2 meningiomas that recur despite maximal surgical resection and adjuvant fractionated radiotherapy (RT). We describe a dose escalation strategy of increasing the total tumor radiation dose by adding a stereotactic radiosurgery (SRS) boost targeting gross disease to fractionated RT.</p><p><strong>Methods: </strong>A single-institution retrospective cohort of patients from 2009-2023 with grade 2 meningioma treated with surgical resection, fractionated RT, and SRS boost were evaluated for baseline characteristics, local disease control, and adverse events (AE).</p><p><strong>Results: </strong>Fourteen meningioma patients were included. Ten patients (71.4%) underwent radiosurgery at initial diagnosis, while 4 patients (28.6%) were treated for recurrent disease. The median fractionated dose was 54 Gy, while the median dose for SRS was 7.5 Gy. Among the 13 patients with follow-up available, median follow-up was 34 months. Three patients (23%) had treatment failures; however, none occurred within the SRS volume and 2 thirds occurred in patients treated for recurrent disease. Eighteen-month progression-free survival was 92.3%, while 18-month overall survival was 100%. Most patients experienced no or mild AEs; however, 3 patients (23%) experienced a high-grade (Common Terminology Criteria for Adverse Events v5.0 grade ≥3) AE including radiation necrosis, seizures, and cognitive decline.</p><p><strong>Conclusions: </strong>We found 100% in-field local control at 3 years from an SRS boost to fractionated RT targeting gross disease with an acceptable toxicity profile, suggesting this may be an effective and improved adjuvant treatment strategy in patients with grade 2 meningioma.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123429"},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695859","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":"Gender Disparities and Their Impact on the Professional Experiences of Female Neurosurgery Residents in Germany: A Cross-Sectional Survey.","authors":"Mazin Omer, Thuy Linh Nguyen, Akram A Alhamdan, Kathrin Machetanz, Dorothea Nistor-Gallo, Ina Moritz, Tatiana Rivera Ramirez, Da Bin Kim, Anna C Lawson McLean, Stefanie Maurer, Jussi P Posti","doi":"10.1016/j.wneu.2024.11.067","DOIUrl":"10.1016/j.wneu.2024.11.067","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in gender equality within neurosurgery, the field continues to encounter challenges related to the under-representation of women and reports of gender-based disparities. This study examines the impact of these disparities on the experiences, professional development, and well-being of female neurosurgery residents in Germany, identifying specific challenges within the neurosurgical community.</p><p><strong>Methods: </strong>An anonymous, questionnaire-based survey was conducted among female neurosurgery residents from various German training hospitals nationwide, using a quantitative approach. Data were collected from June 2021 to January 2023.</p><p><strong>Results: </strong>A total of 63 female neurosurgery residents participated, representing about 19% of all female neurosurgery residents in Germany. Seventy percent reported experiencing incidents of discrimination during training, with 39% encountering \"sometimes\" emotional abuse, 20% physical abuse, and 17% \"rarely\" experiencing sexual harassment. Eighty-six percent did not report these incidents, primarily due to doubts about reporting effectiveness (24%) and the belief that reporting would not lead to change (24%). Discrimination significantly impacted job satisfaction (56%) and career progression (71%). Additionally, 60% reported frequent frustration, 52% experienced occasional depression, and burnout was common.</p><p><strong>Conclusions: </strong>The survey highlights gender disparities affecting female neurosurgery residents in Germany, negatively influencing job satisfaction and career advancement. Tackling gender discrimination and harassment requires a multifaceted approach, and further studies are warranted to assess these methods. The neurosurgical community must ensure a supportive environment by adopting no-tolerance policies against discrimination for all residents, paving the way for a future where professional excellence and patient care are free from gender inequalities.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123484"},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693662","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":"Prognostic Value of Apparent Diffusion Coefficient for Mechanical Thrombectomy in Patients with Acute Posterior Ischemic Stroke.","authors":"Xinze Guo, Xiaopan Cao, Qian Sun, Honghao Li, Yang Zhang, Yi Sui","doi":"10.1016/j.wneu.2024.11.041","DOIUrl":"10.1016/j.wneu.2024.11.041","url":null,"abstract":"<p><strong>Background: </strong>This study investigates the prognostic value of the apparent diffusion coefficient (ADC) in magnetic resonance imaging for patients with acute posterior circulation stroke (PCS) undergoing endovascular therapy (EVT).</p><p><strong>Methods: </strong>A retrospective analysis was conducted of patients with acute PCS from January 2017 to December 2021, confirmed by diffusion-weighted imaging (DWI)-ADC within 24 hours of onset. Patients were categorized based on their 3-month modified Rankin Scale score after EVT. Data on the National Institutes of Health Stroke Scale at admission, ADC value, and 3-month modified Rankin Scale score were collected. Multivariable logistic regression analyzed the impact of various factors on ADC values. The receiver operating characteristic curve assessed predictive indices.</p><p><strong>Results: </strong>Among 94 patients, 47 had a good prognosis and 47 had a poor prognosis. Univariate analysis showed that factors significantly associated with a good prognosis included lower National Institutes of Health Stroke Scale at admission, higher ADC values, smaller infarct areas, unilateral infarction, basilar artery occlusion, lower pons-midbrain-thalamus scores, intravenous thrombolysis, intra-arterial thrombolysis, and fewer perioperative complications (P < 0.05). Multivariable logistic regression identified high ADC values (P = 0.002) and unilateral infarction (P = 0.017) as independent predictive factors for prognosis. An ADC value >549 × 10^-6 mm²/second was associated with a higher rate of good prognosis. Combining ADC values with unilateral infarction resulted in the highest area under the curve and Youden Index of 0.766, with sensitivity and specificity of 89.36% and 87.23%, respectively (P < 0.05).</p><p><strong>Conclusions: </strong>High ADC values and unilateral infarction are independent predictive factors for the prognosis of patients with PCS after EVT. Combining these factors provides the highest predictive accuracy, aiding in clinical decision making for PCS treatment.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123458"},"PeriodicalIF":1.9,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693636","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}