World neurosurgery最新文献

{"title":"Should Proximal Fixation be at C2 or C3-C4? An Application of the Operative Value Index for Elective Posterior Cervical Decompression and Fusion","authors":"Advith Sarikonda ,&nbsp;D. Mitchell Self ,&nbsp;Danyal Quraishi ,&nbsp;Ashmal Sami ,&nbsp;Emily L. Isch ,&nbsp;Steven Glener ,&nbsp;Joshua Heller ,&nbsp;Srinivas Prasad ,&nbsp;Ashwini Sharan ,&nbsp;Jack Jallo ,&nbsp;Alexander R. Vaccaro ,&nbsp;James Harrop ,&nbsp;Ahilan Sivaganesan","doi":"10.1016/j.wneu.2025.123898","DOIUrl":"10.1016/j.wneu.2025.123898","url":null,"abstract":"<div><h3>Background</h3><div>There is clinical equipoise regarding the ideal upper instrumented vertebrae (UIV) for elective posterior cervical decompression and fusion (PCDF). Instrumentation may be performed at the axial C2 level, or at the subaxial C3/C4 vertebrae. To our knowledge, a true “value” (outcomes per dollar spent) comparison axial versus subaxial UIV for PCDF has never been performed.</div></div><div><h3>Methods</h3><div>We retrospectively identified 275 long-segment (≥3-levels fused) PCDFs with available Neck Disability Index (NDI) scores at baseline and at 3 months postoperatively. C2 UIV (n = 67) was compared to C3/C4 UIV (n = 208). Time-driven activity-based costing was applied to identify the true intraoperative costs for each case. The Operative Value Index (OVI) was defined as the percent improvement in NDI score from baseline, per $1000 spent intraoperatively. Multivariable regression analysis was performed to compare intraoperative costs and OVI between C2 and C3/C4 UIV.</div></div><div><h3>Results</h3><div>The average total cost of a C2 construct was $13,751 ($5247), compared with $10,778 ($2237) for C3/C4 (<em>P</em> &lt; 0.001). Forty percent of C2 cases and 32% of C3/C4 cases, respectively, achieved clinically significant improvement in NDI. On multivariable regression analysis, C2 UIV was associated with significantly higher total cost (beta-coefficient: $1814 ± 553, <em>P</em> = 0.001), supply cost (beta-coefficient: $1185 ± $482, <em>P</em> = 0.015) and personnel cost (beta-coefficient: $275 ± $116, <em>P</em> = 0.019). However, there was no significant difference in OVI (<em>P</em> = 0.155) between C2 and C3/C4 UIV.</div></div><div><h3>Conclusions</h3><div>Although the C2 UIV construct incurred significantly higher intraoperative costs compared with C3/C4 UIV, there was no significant difference in “value” between axial and subaxial UIV.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123898"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639845","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":"Epidermoid Cyst of the Skull: A Case Highlighting Long-Term Evolution and Advanced Imaging Features","authors":"Zi-Lin Zhao,&nbsp;Cong Huang","doi":"10.1016/j.wneu.2025.123893","DOIUrl":"10.1016/j.wneu.2025.123893","url":null,"abstract":"<div><div>This study presents a congenital cranial epidermoid cyst with an unprecedented 70-year latency period, elucidating its distinct clinicoradiological features. A 72-year-old woman presented with a slowly enlarging, painless mass in the left frontoparietal region. Imaging revealed skull erosion, restricted diffusion on diffusion-weighted imaging, and hypoperfusion on perfusion-weighted imaging. Cinematic rendering was innovatively applied, providing three-dimensional visualization of intracystic cholesterol deposits and calcifications, which guided precise surgical excision (pathologically confirmed keratin debris). Key takeaways include identification of exceptionally prolonged latency (longest documented), advocating lifelong surveillance; demonstration of superiority of cinematic rendering in resolving complex internal architecture (e.g., solid-cystic interfaces, heterogeneous components), revolutionizing preoperative evaluation protocols; and establishment of a multimodal imaging signature (restricted diffusion + hypoperfusion + computed tomography density heterogeneity) strongly correlated with histologic constituents (keratin/calcifications), enhancing diagnostic specificity. This study provides novel evidence for personalized management and advanced imaging assessment of cranial epidermoid cysts.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123893"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639875","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":"Microsurgical Anatomy of Periventricular White Matter from the Endoventricular Perspective","authors":"Simon Diaz ,&nbsp;J.C. Andrade ,&nbsp;Victoria Dembour ,&nbsp;Guillaume Dannhoff ,&nbsp;Christophe Destrieux ,&nbsp;I.L. Maldonado","doi":"10.1016/j.wneu.2025.123895","DOIUrl":"10.1016/j.wneu.2025.123895","url":null,"abstract":"<div><h3>Background</h3><div>Understanding the spatial disposition of fiber bundles is a requisite for efficient operative planning in cerebral surgery, respecting the most eloquent structures even when not seen by the naked eye. In this study, we used fiber dissection to show critical relationships between the lateral ventricles and white matter fasciculi.</div></div><div><h3>Methods</h3><div>Twenty cerebral hemispheres obtained from body donation were used to study the lateral ventricles, white matter tracts, and their anatomic relationships. We used a variant of the method described by Ludwig and Klingler for fiber dissection, from inside the ventricular cavity after removing the ependyma.</div></div><div><h3>Results</h3><div>After removing the ventricular ependyma, adjacent structures were exposed. Corpus callosum fibers form the roof of the lateral ventricle, as well as the anterior wall and floor of the frontal horn. The tapetum, optic radiations, and association fasciculi dominate in the atrium and occipital horn, with distinct fiber orientation patterns. The medial wall of the occipital horn is marked by the presence of the major forceps fibers underneath the bulb of the corpus callosum. The temporal horn walls are characterized by multiple elements, including the hippocampus medially, tapetum fibers laterally and posteriorly, and key neighboring bundles, such as the optic radiations superiorly and the inferior longitudinal fasciculus inferiorly.</div></div><div><h3>Conclusions</h3><div>Fiber dissection through ependyma removal is an effective method for studying anatomic relationships with adjacent white matter bundles, important for developing a precise anatomic mental picture necessary for effective and safe brain surgery.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123895"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639888","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":"Construction and Evaluation of a Prognostic Columnar Graphic Model for Adult Patients with Diffuse Midline Gliomas","authors":"Wangxiang Mai ,&nbsp;Yuting Tang ,&nbsp;Weiyi He ,&nbsp;Changsen Zhu ,&nbsp;Bing Feng ,&nbsp;Jun Lyu ,&nbsp;Zhuoming Chen","doi":"10.1016/j.wneu.2025.123901","DOIUrl":"10.1016/j.wneu.2025.123901","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the prognostic factors of adult patients with diffuse midline glioma (DMG), and to further construct and evaluate prognostic columnar graphic models to provide some reference for the clinical management of this group of patients.</div></div><div><h3>Methods</h3><div>We included adult patients with histologically confirmed DMG from the SEER (Surveillance Epidemiology and End Results) database (2004–2015), dividing them into training and validation sets (7:3 ratio). Using Kaplan-Meier and Cox regression analyses, we determined independent prognostic factors for overall survival (OS) and cancer-specific survival (CSS). Prognostic column-line graphic models were developed for OS and CSS, incorporating patient demographics and clinical characteristics. The models underwent internal and external validation, with performance assessed using the Concordance Index, area under the curve values, and calibration plots.</div></div><div><h3>Results</h3><div>The study encompassed 226 patients, showing age, tumor extension, and World Health Organization grades as significant prognostic factors. The constructed models for OS and CSS showed moderate reliability and predictive accuracy, with Concordance Index values of 0.786 (OS) and 0.79 (CSS) in the training set and 0.743 (OS) and 0.787 (CSS) in the validation set. Calibration plots and decision curve analysis confirmed the clinical usefulness of the models.</div></div><div><h3>Conclusions</h3><div>The column-line graphic prediction models for OS and CSS have moderately reliable predictive efficacy and help clinicians to better assess the prognosis and provide individualized treatment options for adults with DMG.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123901"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639863","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":"Curative Treatment of Brain Arteriovenous Malformations Combining Endovascular and Surgical Approaches Consecutively","authors":"Ran Brauner ,&nbsp;Stanislas Smajda ,&nbsp;Dorian Chauvet ,&nbsp;Sorin Aldea ,&nbsp;Simon Escalard ,&nbsp;Jean-Philippe Désilles ,&nbsp;Hocine Redjem ,&nbsp;Amira Al Raaisi ,&nbsp;Humain Baharvahdat ,&nbsp;William Boisseau ,&nbsp;Raphael Blanc ,&nbsp;Michel Piotin","doi":"10.1016/j.wneu.2025.123896","DOIUrl":"10.1016/j.wneu.2025.123896","url":null,"abstract":"<div><h3>Background</h3><div>Brain arteriovenous malformations (AVMs) pose a significant treatment challenge, with options including microsurgical resection, endovascular embolization, radiosurgery, or combinations thereof. We present our experience with a curative strategy combining complete endovascular treatment followed by microsurgical resection under the same anesthesia session, without relying on a hybrid operating room.</div></div><div><h3>Methods</h3><div>We reviewed consecutive patients with AVM who underwent endovascular treatment and microsurgical resection in a single anesthesia session (COMBI-AVM protocol) from December 2017 to July 2022. Primary endpoints were angiographic AVM obliteration status and modified Rankin Scale score at last follow-up. AVMs were graded by the Spetzler-Martin (SM) system, comparing low-grade (SM I, SM II, SM III with nidus &lt;3 cm) and high-grade (SM III with nidus ≥3 cm, SM IV, SM V) AVMs.</div></div><div><h3>Results</h3><div>Of 46 patients with AVM, 34 had low-grade (73.9%) and 12 had high-grade (26.1%) AVMs. The protocol feasibility was 100%. Median anesthesia time was 8.7 hours (interquartile range, 7.6–10.6). Complete AVM removal was achieved in 45 patients (97.8%), with no recurrences at late (&gt;6 months) follow-up in any of the 32 patients (71.1%) with available follow-up data. Good clinical outcomes (modified Rankin Scale score ≤2) were seen in 91.3% of patients. Disabling treatment-related complications occurred in 4 patients (8.6%), including 1 death (2.2%).</div></div><div><h3>Conclusions</h3><div>Combining maximal endovascular embolization and complete surgical resection in a single session in patients with AVM yielded a high cure rate and low morbidity, especially for low-grade lesions. This technique may make it possible to treat high-grade AVMs previously considered ineligible for surgery and reduce periprocedural morbidity.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123896"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639869","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":"Multiple Hippocampal Transections: Initial Clinical Experience with Modified Technique","authors":"Jan Šroubek ,&nbsp;Lenka Krámská ,&nbsp;Michaela Nová ,&nbsp;Matěj Červenka ,&nbsp;Barbora Míková ,&nbsp;Tomáš Česák ,&nbsp;Jan Klener ,&nbsp;Martin Kovář ,&nbsp;Zdeněk Vojtěch","doi":"10.1016/j.wneu.2025.123804","DOIUrl":"10.1016/j.wneu.2025.123804","url":null,"abstract":"<div><h3>Objective</h3><div>Standard resective treatment of mesial temporal lobe epilepsy (MTLE) includes anteromesial temporal resection or amygdalohippocampectomy. One potential risk of these surgeries, especially in patients with magnetic resonance imaging (MRI)-negative findings, is postoperative memory impairment. An alternative to resective procedures that aim to preserve the neuropsychological profile are multiple hippocampal transections (MHTs). The objective of transections is to interrupt the longitudinal pathways of the hippocampus to prevent the spread of epileptic seizures while preserving the memory circuits.</div><div>Previously performed MHT procedures were guided by questionable intraoperative electrocorticography. At our institution, we have developed and tested a modified technique to achieve complete MHTs.</div></div><div><h3>Methods</h3><div>Patients with pharmacoresistant unilaterally lateralized MTLE and MRI-negative findings with high risk of neuropsychologic deterioration were indicated for complete MHT. Comprehensive neuropsychological and epileptological evaluations and MRI follow-ups were conducted 1 year and 2 years postoperatively. The primary evaluated parameters were seizure reduction and significant changes in neuropsychological performance (± 1 SD).</div></div><div><h3>Results</h3><div>Complete MHTs were performed on 3 patients who completed 2-year follow-up. Two MHTs were performed on the right and 1 on the left side. Two patients are classified as Engel 1 and one patient as Engel 3. Two years after surgery, neuropsychologic evaluation did not show significant decrease in memory performance and performance in majority of cognitive tests. One-year MRI follow-up showed decrease of volume of hippocampus in all 3 patients.</div></div><div><h3>Conclusions</h3><div>This modified technique of MHT in patients with MTLE and MRI-negative findings led to seizure reduction while preserving their neuropsychologic performance.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123804"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473136","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":"In Reply to the Letter to the Editor Regarding “Radiologic Clue to Cavernous Sinus Hemangioma Diagnosis”","authors":"Cristiano Esteves ,&nbsp;David Berhanu ,&nbsp;Carla Guerreiro","doi":"10.1016/j.wneu.2025.123813","DOIUrl":"10.1016/j.wneu.2025.123813","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123813"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469197","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":"In Reply to the Letter to the Editor: \"Regarding Cognition in Meningioma: Effects of Tumor Location and Tumor Removal\"","authors":"Islay Barne ,&nbsp;Christine E. Wells ,&nbsp;Miranda Wheeler ,&nbsp;Helen Bairstow ,&nbsp;Donald Brechin ,&nbsp;Stephen Evans ,&nbsp;Colin Lever","doi":"10.1016/j.wneu.2025.123892","DOIUrl":"10.1016/j.wneu.2025.123892","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123892"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639880","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":"Ultrasonic Hemodynamics of Middle Meningeal Artery in Chronic Subdural Hematoma","authors":"Xinrun Wang ,&nbsp;Zhensheng Liu ,&nbsp;Tingyue Qi ,&nbsp;Yanhui Shi ,&nbsp;Wanwan Hou ,&nbsp;Wen Zhang","doi":"10.1016/j.wneu.2025.123793","DOIUrl":"10.1016/j.wneu.2025.123793","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the feasibility of color Doppler ultrasound (CDUS) in detecting the middle meningeal artery (MMA) and evaluate the clinical application of this method in chronic subdural hematoma (CSDH).</div></div><div><h3>Methods</h3><div>This study collected clinical data from 100 patients with CSDH who were admitted to our hospital between January 2023 and March 2024. Among these patients, 87 underwent drilling and drainage surgery. Postoperative follow-up categorized patients into a recurrence group and a nonrecurrence group. Additionally, 80 healthy volunteers and 60 patients with acute subdural hematoma were selected as the control group. Using CDUS technology, the MMA was assessed through the infratemporal fossa in the half-mouth position to obtain peak systolic flow velocity (PSV), end diastolic flow velocity, and resistance index (RI). Comparisons were conducted between the study group and the control group, as well as between the recurrence and nonrecurrence groups to evaluate hemodynamic differences. Multivariate logistic regression analysis was employed to identify risk factors for postoperative recurrence in patients with CSDH. Receiver operating characteristic curves were generated to assess the sensitivity and specificity of MMA hemodynamic parameters in predicting postoperative recurrence of CSDH.</div></div><div><h3>Results</h3><div>The MMA visualization rates for the CSDH group, healthy volunteer group, and acute subdural hematoma group were 84.43% (103/122), 85.00% (136/160), and 83.33% (70/84), respectively. Multivariate logistic regression analysis indicated that bilateral hematoma, increased PSV, and decreased RI were independent risk factors for the recurrence of CSDH following drilling and drainage (<em>P</em> &lt; 0.05). The maximum Youden index was achieved when the PSV predictive value was 30.85 cm/s and the RI predictive value was 0.78.</div></div><div><h3>Conclusions</h3><div>Utilizing CDUS in a half-open mouth position is a feasible method for evaluating extracranial MMA. Monitoring hemodynamic changes in the MMA of patients with CSDH postsurgery holds significant value in indicating the potential for postoperative recurrence.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123793"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433693","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":"Letter to the Editor Regarding: \"Effectiveness of Mentorships and Early Exposure in Neurosurgery\"","authors":"Durga Neupane ,&nbsp;David J. Park ,&nbsp;Steven D. Chang","doi":"10.1016/j.wneu.2025.123891","DOIUrl":"10.1016/j.wneu.2025.123891","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123891"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639883","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}