World neurosurgery最新文献

{"title":"Comparison of the Orbitozygomatic and Transmandibular Approaches to the Infratemporal Fossa","authors":"Levent Aydin ,&nbsp;Tufan Agah Kartum ,&nbsp;Adem Yilmaz ,&nbsp;Necmettin Tanriover","doi":"10.1016/j.wneu.2025.124439","DOIUrl":"10.1016/j.wneu.2025.124439","url":null,"abstract":"<div><h3>Objective</h3><div>The infratemporal fossa (ITF) represents a complex anatomical region of critical relevance in skull base surgery, particularly due to its involvement in the extension of neoplastic lesions. Surgical access to this region remains technically demanding. The orbitozygomatic (OZ) and transmandibular (TM) approaches offer distinct anatomical perspectives and operative corridors. This study aimed to anatomically compare these two techniques to delineate their microsurgical fields, advantages, and limitations in accessing the ITF.</div></div><div><h3>Material and Methods</h3><div>A total of five silicone-injected, formalin-fixed cadaveric heads (10 sides) were dissected using surgical microscopes at magnifications ranging from ×6 to ×40. A standard OZ craniotomy was performed, followed by progressive drilling of the middle cranial fossa and resection of the greater sphenoid wing to expose the ITF. Subsequently, the TM approach was performed on the same cadavers to evaluate its added exposure. Anatomical landmarks, neurovascular structures, and spatial relationships were meticulously documented and compared across approaches.</div></div><div><h3>Results</h3><div>The OZ approach enabled wide exposure of the anterior and middle ITF, particularly through the anterolateral triangle and foramina of the middle fossa with minimal brain retraction. However, access to the posterior ITF, maxillary artery, and lower cranial nerves was limited. The TM approach, conversely, provided extended visualization of the middle and posterior ITF, superior control of the maxillary artery, and exposure of deep neurovascular structures, including the internal carotid artery and cranial nerves IX–XII. Integration of both approaches offered a complementary panoramic view of the ITF.</div></div><div><h3>Conclusions</h3><div>The OZ approach is optimal for anterior and middle ITF lesions with orbital or cavernous sinus extension, while the TM approach is more effective for posterior ITF pathologies requiring wider vascular and neural access. Combining both strategies may offer a tailored approach for complex skull base surgeries involving the ITF.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124439"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008462","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":"Expandable Cage in Minimally Invasive Transforaminal Lumbar Interbody Fusion: Comparative Data with Static Cage from a Single Institution and a Single Surgeon","authors":"Dongkyu Kim,&nbsp;Hyun Jun Jang,&nbsp;Bong Ju Moon,&nbsp;Kyung Hyun Kim,&nbsp;Sung Uk Kuh,&nbsp;Dong Kyu Chin,&nbsp;Keun Su Kim,&nbsp;Jeong Yoon Park","doi":"10.1016/j.wneu.2025.124428","DOIUrl":"10.1016/j.wneu.2025.124428","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive surgery–transforaminal lumbar interbody fusion (MIS-TLIF) is widely adopted for the treatment of lumbar degenerative disease. Expandable cages are now increasingly used in MIS-TLIF to facilitate disc height restoration in narrow spaces. Despite theoretical advantages, the clinical and radiologic outcomes of expandable cage compared to static cage remain controversial.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed 151 patients who underwent single-level lumbar MIS-TLIF performed by a single surgeon at a single institution, with more than 1-year follow-up. Static cages were exclusively used from May 2022 to March 2023 (n = 76), and expandable cages from April 2023 to March 2024 (n = 75). The primary outcomes were radiological disc height and lordotic angles.</div></div><div><h3>Results</h3><div>The expandable cage group demonstrated significantly greater postoperative disc height restoration compared to the static cage group at both immediate postoperative periods (10.3 ± 1.2 mm vs. 9.5 ± 1.5 mm, <em>P</em> = 0.003) and at 1-year follow-ups (9.6 ± 1.4 mm vs. 9.0 ± 1.6 mm, <em>P</em> = 0.028). There were no significant differences between the groups in lordotic angles, fusion rates, and clinical outcomes. Various complications were also comparable, other than the incidence of cage subsidence &gt; 3 mm, which was higher in the expandable cage group (14.7% vs. 3.9%, <em>P</em> = 0.047).</div></div><div><h3>Conclusions</h3><div>Expandable cages in MIS-TLIF demonstrated superior disc height restoration compared to static cages, which were maintained throughout a 1-year follow-up period despite the relatively higher subsidence rate. No significant differences were observed in terms of lordotic angle restoration, clinical outcomes, or fusion rates.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124428"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006625","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":"Congenital Absence of Posterior Elements of Axis: Case Series, Literature Review, and Classification Proposal","authors":"Chao Liu,&nbsp;Zhiping Mu,&nbsp;Zhengfeng Zhang","doi":"10.1016/j.wneu.2025.124435","DOIUrl":"10.1016/j.wneu.2025.124435","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study is to present 5 new cases of congenital absence of posterior elements of the axis (C2), totaling 17 cases reported in the literature, and to propose an anatomical classification system for this rare condition for standardizing its management.</div></div><div><h3>Methods</h3><div>A retrospective review of 5 patients diagnosed and surgically treated for the absence of C2 posterior elements was conducted from 2017 to 2024. Clinical characteristics were summarized, and imaging studies, including X-rays, computed tomography, and magnetic resonance imaging, were performed to define abnormalities and cord compression. Surgical approaches were selected based on anatomical features and the new classification. The rare disease was classified into type I (C2/3 single level) and type II (C1/2 and C2/3 2 levels) based on the level of dislocation or instability.</div></div><div><h3>Results</h3><div>All patients presented with C2/C3 instability or dislocation and underwent surgery. The classification system further categorized cases into type Ia, Ib, and Ic, based on the abnormalities of C0-C1 and C1-C2 in type I, and applied to 17 cases in total. Postoperatively, neurological status improved in all patients.</div></div><div><h3>Conclusions</h3><div>This study proposes a classification system for congenital absence of posterior C2 elements and demonstrates its utility in guiding surgical treatment.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124435"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008493","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":"Spinopelvic Outcomes of Distal Lumbar Short-Segment Fusion in Recurrent Lumbar Disc Herniation: A Preoperative and Postoperative Comparative Analysis with Roussouly Classification","authors":"Gültekin Bas ,&nbsp;Salim Tekir ,&nbsp;Hakan Bozoglu ,&nbsp;Fatih Saglam ,&nbsp;Zühtü Ozbek","doi":"10.1016/j.wneu.2025.124438","DOIUrl":"10.1016/j.wneu.2025.124438","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the effects of distal lumbar short-segment fusion (dSSF) on spinopelvic parameters and sagittal alignment in patients with recurrent lumbar disc herniation, with outcomes analyzed according to Roussouly classification.</div></div><div><h3>Methods</h3><div>A retrospective single-center cohort study included 38 patients with recurrent lumbar disc herniation who underwent open L4-L5 or L5-S1 dSSF between January 2015 and December 2023. Preoperative and postoperative spinopelvic parameters, including global lumbar lordosis (gLL), proximal lumbar lordosis, distal lumbar lordosis (dLL), pelvic tilt, sacral slope, and pelvic incidence-lumbar lordosis (PI-LL) mismatch, were measured using Nucleus Software. Patients were categorized into Roussouly types (RTs) (RT-1 to RT-4). Statistical analyses employed paired t-tests or Wilcoxon signed-rank tests for spinopelvic parameter comparisons and chi-square tests for RT distribution, with significance set at <em>P</em> &lt; 0.05.</div></div><div><h3>Results</h3><div>The cohort (20 females, 18 males; mean age 44.34 ± 10.38 years) showed significant postoperative improvements in gLL (44.60° ± 17.64 to 48.70° ± 12.16, <em>P</em> = 0.027), dLL (25.00° ± 10.17 to 27.70° ± 6.70, <em>P</em> = 0.009), and PI-LL mismatch (13.19° ± 17.50 to 3.40° ± 5.56, <em>P</em> = 0.008) in RT-1 patients (n = 19). RT-2 became predominant postoperatively (<em>P</em> = 0.006). Pelvic tilt and sacral slope changes were insignificant across all groups. RT-2, RT-3, and RT-4 showed minimal spinopelvic parameter alterations, indicating limited impact in nonhypolordotic profiles.</div></div><div><h3>Conclusions</h3><div>dSSF significantly enhances gLL, dLL, and PI-LL mismatch, particularly in RT-1 patients, suggesting improved sagittal balance in hypolordotic spines. Larger prospective studies with clinical outcomes are warranted to validate long-term efficacy.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124438"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008436","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":"Evaluation of Intraoperative Adverse Events and Perioperative Outcomes in Pediatric Neurosurgery","authors":"Maximilian Middelkamp ,&nbsp;Richard Drexler ,&nbsp;Friederike S. Groth ,&nbsp;Thomas Sauvigny ,&nbsp;Franz L. Ricklefs ,&nbsp;Gertrud Kammler ,&nbsp;Eva M. Zeidler ,&nbsp;Lasse Dührsen","doi":"10.1016/j.wneu.2025.124434","DOIUrl":"10.1016/j.wneu.2025.124434","url":null,"abstract":"<div><h3>Objective</h3><div>Quality monitoring and improvement are crucial in pediatric neurosurgery for effective risk assessment and surgical preparation. This study evaluates the reliability of the ClassIntra classification for intraoperative complications and its potential for predicting postoperative outcomes in pediatric patients.</div></div><div><h3>Methods</h3><div>In this prospective cohort study at a tertiary care center, we analyzed 47 pediatric patients undergoing various neurosurgical procedures. Data were systematically collected throughout the perioperative period, focusing on preoperative characteristics, intraoperative variables, and postoperative recovery metrics.</div></div><div><h3>Results</h3><div>The cohort was categorized using the ClassIntra grading system into 3 groups: CI = 0 (N = 24), CI = 1 (N = 20), and CI ≥ 2 (N = 3). The mean age was 7.0 years, with no significant demographic differences across groups. Operative times increased with higher ClassIntra grades (126.6 minutes for CI = 0, 227.6 minutes for CI = 1, and 260.7 minutes for CI ≥ 2; <em>P</em> = 0.01). Patients with major intraoperative adverse events showed higher neurological deterioration (<em>P</em> = 0.03) and increased 90-day readmission rates in the CI ≥ 2 group (<em>P</em> &lt; 0.01).</div></div><div><h3>Conclusions</h3><div>Intraoperative complications significantly affect postoperative recovery in pediatric neurosurgery. Longer operative times and worse neurological outcomes correlate with higher ClassIntra ratings, emphasizing the need for improved monitoring and risk-reduction strategies.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124434"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008423","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":"Most Roads Lead to Cushing: Mapping Neurosurgical Training Lineages in the United States","authors":"David B. Kurland ,&nbsp;Minjun Park ,&nbsp;Avi A. Gajjar ,&nbsp;Albert Liu ,&nbsp;Douglas Kondziolka ,&nbsp;John G. Golfinos ,&nbsp;Cargill H. Alleyne Jr. ,&nbsp;Eric K. Oermann","doi":"10.1016/j.wneu.2025.124433","DOIUrl":"10.1016/j.wneu.2025.124433","url":null,"abstract":"<div><h3>Objective</h3><div>Mentorship and training relationships shape the careers and influence of neurosurgeons. Network analysis can reveal structural characteristics and key individuals who support network connectivity and drive the field's development. This endeavor analyzed the U.S.-based neurosurgical training network derived from NeurosurGen.com.</div></div><div><h3>Methods</h3><div>A network graph was constructed representing neurosurgical training relationships, including chairperson–trainee, program director–trainee, and coresident connections. Graph- and node-level metrics, with a focus on centrality measures, were calculated for a trainer–trainee subgraph.</div></div><div><h3>Results</h3><div>The network consisted of 8840 neurosurgeons represented as nodes, and 382,143 relationships represented as edges. It evolved from an early small-world structure to a hierarchical and decentralized structure dominated by local clusters. Demographic shifts over time reflected increasing diversity and inclusion, with greater representation of female, Hispanic, Asian, and Black trainees across 285 training programs. Nodes were preferentially connected via residency, and the connectivity among underrepresented populations improved in concert with increased representation. Harvey W. Cushing was the quintessential neurosurgeon-influencer in the United States, ranking highly across most centrality measures over time.</div></div><div><h3>Conclusions</h3><div>The neurosurgical training network is sparse but interconnected, typical of large real-world professional networks. While many small groups of neurosurgeons are closely tied within their immediate training hierarchy and peer group, in modern neurosurgery, each surgeon is only connected to a small fraction of the total network. Highly central individuals have played critical roles in linking disparate groups and shaping network structure. Increasing diversity in recent decades indicates progress toward inclusivity, although overall representation remains low.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124433"},"PeriodicalIF":2.1,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply to the Letter to the Editor Regarding “Drainage versus Nondrainage for Thoracolumbar Spine Surgery: An Evidence Synthesis”","authors":"Shichao Liu ,&nbsp;Jingyu Zhou","doi":"10.1016/j.wneu.2025.124429","DOIUrl":"10.1016/j.wneu.2025.124429","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124429"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006642","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":"Trigeminal Microvascular Decompression for Medically Refractory Short-Lasting Unilateral Neuralgiform Headache Attacks: A Single-Center Retrospective Analysis","authors":"Sinan Barazi ,&nbsp;Ho Lim Pak ,&nbsp;Eleni Maratos ,&nbsp;Steve Connor ,&nbsp;Giorgio Lambru","doi":"10.1016/j.wneu.2025.124432","DOIUrl":"10.1016/j.wneu.2025.124432","url":null,"abstract":"<div><h3>Objective</h3><div>This analysis aims to evaluate the sustained effectiveness of trigeminal microvascular decompression (MVD) in patients with medically refractory short-lasting unilateral neuralgiform headache attacks (SUNHA) who demonstrate trigeminal neurovascular conflict (NVC) ipsilateral to the painful side.</div></div><div><h3>Methods</h3><div>This is a retrospective single-center analysis of prospectively collected data conducted between September 2012 and March 2025 to investigate the efficacy and safety of trigeminal MVD in consecutive refractory chronic SUNHA patients suitable for surgery. All patients underwent a magnetic resonance imaging with specific trigeminal sequences before surgery. The 5-point Barrow Neurological Institute (BNI) pain intensity score was used to quantify the response to surgery. Patients with a BNI of 1–2 at the final postsurgery follow-up were considered responders.</div></div><div><h3>Results</h3><div>The study group consisted of 19 SUNHA patients (n = 7 female), with a mean age of 58 (±12, range 35–81), refractory to medical therapy (BNI score = 5), who underwent trigeminal MVD. Of the 18 patients included in the analysis, trigeminal NVC with morphological changes was found in 13 patients (72.2%). Postoperatively, 16 patients (89.0%) were responders. Two patients had a BNI score of 3, reflecting a partial improvement (11.1%). The mean postsurgery follow-up was 54.3 months (±36.7, range 2–163 months). At the final follow-up, 13 patients remained responders (72.2%). One patient reported transient postoperative dizziness, and 1 patient reported pain in the incision site.</div></div><div><h3>Conclusions</h3><div>Trigeminal MVD may be a safe and effective treatment modality for those patients with medically refractory SUNHA with magnetic resonance imaging evidence of trigeminal NVC with morphological changes.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124432"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006609","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":"Small Ruptured Anterior Communicating Artery Aneurysms in the Endovascular Right-of-First-Refusal Era: Intraprocedural Rupture Risk and Retreatment at Follow-Up","authors":"Li Ma ,&nbsp;Samer S. Hoz ,&nbsp;Prateek Agarwal ,&nbsp;Rachel C. Jacobs ,&nbsp;Alhamza R. Al-Bayati ,&nbsp;Raul G. Nogueira ,&nbsp;Georgios A. Zenonos ,&nbsp;Paul A. Gardner ,&nbsp;Robert M. Friedlander ,&nbsp;Michael J. Lang ,&nbsp;Bradley A. Gross","doi":"10.1016/j.wneu.2025.124430","DOIUrl":"10.1016/j.wneu.2025.124430","url":null,"abstract":"<div><h3>Background</h3><div>Ruptured small anterior communicating artery (ACoA) aneurysms can pose a technical challenge for endovascular therapy. We sought to explore treatment and follow-up results in the modern endovascular right of first refusal era.</div></div><div><h3>Methods</h3><div>Smaller (≤7 mm) ruptured aneurysms of the ACoA undergoing treatment were compared with non-ACoA counterparts and further dichotomized by size (≤3 mm and 3–7 mm). Immediate and 2-year angiographic results, procedural complications, retreatment, and functional results at follow-up were stratified by treatment modalities and compared between aneurysm location and size groups.</div></div><div><h3>Results</h3><div>Of 449 consecutive small ruptured aneurysms, 35% (n = 155) were ACoA. Endovascular treatment was the first-line option in 68%. While the immediate aneurysm occlusion was more favorable in the ACoA group compared to other aneurysms treated endovascularly (Raymond-Roy I-II, 89% vs. 74%, <em>P</em> = 0.003), the residual and/or recanalization requiring retreatment rate at 2 years was higher (27% vs. 17%, <em>P</em> = 0.04). ACoA aneurysms were associated with a 2-fold higher risk of retreatment (odds ratio [OR] 2.08, <em>P</em> = 0.02) in multivariate analyses of the endovascular cohort. The incidence of intraprocedural rupture was numerically higher for coiled ≤3 mm ACoA aneurysms (12.5% vs. 2.2%, <em>P</em> = 0.11), corresponding to a higher major complication rate (12.5% vs. 1.1%, <em>P</em> = 0.06) in this subgroup. Endovascularly treated ≤3 mm ACoA aneurysms were associated with a 4-fold higher risk of recanalization (OR 4.4, <em>P</em> = 0.01) and retreatment (OR 3.8, <em>P</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>While the immediate efficacy is satisfactory for endovascularly treated small ruptured ACoA aneurysms, there are increasing needs for retreatment and non-negligible risks for coiling ACoA aneurysms ≤3 mm.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"203 ","pages":"Article 124430"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006635","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":"Occipital Monitoring of Patient State Index During Frontal Tumor Resection: A Feasibility Study","authors":"Ya-xian Huang ,&nbsp;Wei Xiao ,&nbsp;Chun-xiu Wang ,&nbsp;Tian-long Wang","doi":"10.1016/j.wneu.2025.124425","DOIUrl":"10.1016/j.wneu.2025.124425","url":null,"abstract":"<div><h3>Background</h3><div>Frontal patient state index (PSI) monitoring is impractical during frontal lobe tumor resection due to surgical field interference. No validated alternative monitoring positions exist currently. This study evaluated the agreement between standard frontal and experimental occipital PSI monitoring.</div></div><div><h3>Methods</h3><div>A SedLine sedation monitor was used to record frontal and occipital PSI values in 16 patients who underwent frontal lobe tumor resection. PSI data were collected at 2-second intervals starting from sensor attachment to headframe fixation. Agreement was assessed using the Bland-Altman analysis and intraclass correlation coefficient. Subgroup analyses evaluated tumor laterality. A Passing-Bablok regression established predictive equations between frontal and occipital PSI at 7 critical time points.</div></div><div><h3>Results</h3><div>Frontal and occipital PSI trends showed high temporal synchrony (<em>P</em> = 0.08) with a strong positive correlation (R² = 0.805, <em>P</em> &lt; 0.001). Bland-Altman analysis demonstrated excellent agreement (mean log-transformed difference: −0.02; 95% limits of agreement: −0.82 to 0.80). The intraclass correlation coefficient of all data was 0.82 (95% confidence interval: 0.816–0.830, <em>P</em> &lt; 0.001). Tumor laterality did not significantly affect frontal–occipital PSI differences (<em>P</em> = 0.382). A Passing-Bablok regression equation was derived to predict frontal PSI from occipital measurements: <span><math><mrow><mi>e</mi><mi>P</mi><mi>S</mi><mi>I</mi><mo>=</mo><mn>0.37</mn><mo>×</mo><msup><mrow><mo>(</mo><mrow><mi>z</mi><mi>P</mi><mi>S</mi><mi>I</mi></mrow><mo>)</mo></mrow><mn>1.28</mn></msup></mrow></math></span>.</div></div><div><h3>Conclusions</h3><div>Occipital PSI demonstrates excellent agreement with frontal PSI during frontal tumor resection, offering a viable alternative to obstructed frontal monitoring. Prospective validation via multi-center continuous intraoperative monitoring constitutes the essential next step.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"202 ","pages":"Article 124425"},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006705","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}