World neurosurgery最新文献

{"title":"Identification of an Operative Time Threshold for Substantially Increased Postoperative Complications Following Thoracolumbar Spine Surgery: A Nationwide Retrospective Cohort Analysis.","authors":"Bilal Moiz, Khaled M Taghlabi, Isuru Somawardana, Rijul Nanda, Lokeshwar S Bhenderu, Jaime R Guerrero, Aboud Tahanis, Amir H Faraji","doi":"10.1016/j.wneu.2025.123897","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123897","url":null,"abstract":"<p><strong>Importance: </strong>The literature extensively describes the influence of operative time (OT) on postoperative outcomes, but the extent of its impact on thoracolumbar fusion (TLF) outcomes remains unclear. This study aims to identify the threshold beyond which OT increases the risk of surgical adverse events and quantify the association between increased OT and postoperative complications.</p><p><strong>Design: </strong>A total of 66,904 patients who underwent thoracolumbar fracture surgery between 2010-2021 were identified from the College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset. We used receiver operating characteristic curve to determine an OT threshold that significantly increased 30-day morbidity. Univariate analysis was performed before and after propensity matching for covariates. Multivariate regression was used to further validate the risk of OT on 30-day morbidity.</p><p><strong>Results: </strong>A total of 66,898 patients met inclusion criteria, of which 20% experienced 30-day morbidity and 0.38% 30-day mortality. An OT threshold of 215 minutes best discriminates risk of 30-day morbidity. On univariate analysis, longer OT was significantly associated with all cause 30-day morbidity (OR, 3.28; 95% CI, 3.12-3.45), including wound infection, increased length of stay, deep vein thrombosis, bleeding requiring transfusion, pneumonia, pulmonary embolism, urinary tract infection, and failure to wean off ventilation. Further analysis with multivariate regression validated that OT was independently associated with an increased risk of overall complications (OR 3.50, CI: 3.25 - 3.78, p<0.0001).</p><p><strong>Conclusions: </strong>This study demonstrates that OT ≥ 215 minutes is strongly associated with increased incidence of postoperative adverse events and longer hospital length of stay following thoracolumbar spine fixation.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123897"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634750","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":"Application of Multimodal Image Fusion 3D Reconstruction Technology Combined with 3D Printing Guide Plate in Meningioma Surgery","authors":"Jinhai Zhao ,&nbsp;Hongyue Huo ,&nbsp;Jianxin Jiang","doi":"10.1016/j.wneu.2025.123768","DOIUrl":"10.1016/j.wneu.2025.123768","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the value of multimodal image fusion three-dimensional (3D) reconstruction technology combined with 3D-printed guide plates in meningioma surgery.</div></div><div><h3>Methods</h3><div>The clinical data of 16 patients with meningioma who underwent tumor resection at Taizhou People's Hospital between November 2022 and May 2024 were retrospectively analyzed. Preoperative thin-layer computed tomography and magnetic resonance imaging examinations were performed on all patients. Multimodal image fusion and 3D reconstruction were performed on the computed tomography and magnetic resonance imaging data using the 3D Slicer software to create 3D models of the skin, muscle, skull, tumor, cerebrovascular structures, and other relevant anatomical features. These models were used to develop optimal surgical plans and design 3D guide plates. The 3D printing guide promoted precise localization of the tumor on the body surface, assisted in the design of the bone flap and scalp incision, and identified key surgical landmarks. General data, results of multimodal image fusion 3D reconstruction, accuracy of the 3D printing guide, intraoperative data, surgical complications, and follow-up outcomes for all patients were summarized.</div></div><div><h3>Results</h3><div>The surgical approach was successfully planned, and 3D-printed guide plates were created preoperatively based on the multimodal image fusion and 3D reconstruction models. The 3D guides enabled precise body surface localization of the tumor and full exposure of the tumor and peritumoral tissue with the smallest possible bone window. Multimodal image fusion 3D reconstruction images promoted the successful protection of important cerebrovascular structures and brain tissue during surgery. All 16 procedures were successfully completed, with the 3D reconstructed images closely matching the intraoperative observations. The tumor was accurately located beneath the incision and postoperative imaging confirmed complete lesion removal.</div></div><div><h3>Conclusions</h3><div>Multimodal image fusion combined with 3D printing guide technology provides precise localization for meningioma resection, aids in understanding the position of cerebrovascular structures and the skull, prevents deviations in the surgical pathway, optimizes the surgical process, predicts potential intraoperative challenges, increases the success rate of surgery, and decreases the rates of complications and recurrence.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123768"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433964","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":"Topographic Patterns of Recurrence of Olfactory Groove Meningiomas After Transcranial Approach","authors":"Francesco Maiuri,&nbsp;Jacopo Berardinelli,&nbsp;Giuseppe Corazzelli,&nbsp;Federico Russo,&nbsp;Sergio Corvino","doi":"10.1016/j.wneu.2025.123811","DOIUrl":"10.1016/j.wneu.2025.123811","url":null,"abstract":"<div><h3>Background</h3><div>Olfactory groove meningiomas may recur up to 30% of cases. This study focused on the topographic patterns and location of the recurrences and their surgical management.</div></div><div><h3>Methods</h3><div>Data on topography of recurrences from a single-center surgical series of olfactory groove meningiomas were retrospectively reviewed and analyzed along with data from pertinent literature. Analyzed factors included patient age and sex; extent of resection and management of infiltrating dura and skull base at initial surgery; time to recurrence; clinical presentation at recurrence; size, location, and histology of recurrent tumors; and management of recurrent tumors.</div></div><div><h3>Results</h3><div>Overall sample included 33 patients, 4 from our series and 29 from the literature. The main reported symptoms at recurrence were visual function deterioration (67%), nasal obstruction (41%), and headache (40%). The recurrent tumor involved the skull base in all cases (100%). Intracranial regrowth and sinus invasion were observed in 84% of cases. Surgery was performed mainly through the same transcranial approach (76%) or combined transcranial-transnasal approach (17%). Although Simpson grade I resection was possible in more than half of patients, a residual intradural tumor (Simpson grade IV) was left in one third.</div></div><div><h3>Conclusions</h3><div>Recurrences of olfactory groove meningiomas treated by transcranial approach mainly occur at the cranial base, bone, paranasal sinuses, and optic canals. This suggests resecting at the initial surgery the involved dura and bone to decompress the optic pathways. Reoperation should attempt gross total resection, at least in cases with more limited bone invasion.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123811"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472972","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":"Risk Factors for Hemodynamic Depression After Carotid Stenting","authors":"Yaoliang Wang ,&nbsp;Wei Liu ,&nbsp;Yile Zhang ,&nbsp;Ke Mou ,&nbsp;Weizhong Wang ,&nbsp;Xiaodong Shao ,&nbsp;Qianliang Wang ,&nbsp;Lin Yang ,&nbsp;Qingdong Guo","doi":"10.1016/j.wneu.2025.123790","DOIUrl":"10.1016/j.wneu.2025.123790","url":null,"abstract":"<div><h3>Background</h3><div>The effects of different stents and morphology of the stenosis on hemodynamic depression (HD) and in-stent restenosis (ISR) are unclear after carotid artery stenting.</div></div><div><h3>Methods</h3><div>142 patients were retrospectively enrolled and stratified into straight stent and tapered stent (TS), and further stratified according to stenosis morphology to compare the differences in final events. Logistic analysis was used to determine the risk factors for the occurrence of HD.</div></div><div><h3>Results</h3><div>TS had a lower incidence of postprocedural HD (38.8% vs. 60.0%; P = 0.012) and 1-year ISR (1.5% vs. 8.0%; P = 0.078). In centripetal stenosis, there was no significant difference in postprocedural HD between the different stents (27.3% vs. 47.8%; P = 0.155). In contrast, for eccentric stenosis, TS was associated with a reduced risk of postprocedural HD (42.2% vs. 67.3%; P = 0.013). Logistic analyses found that eccentric stenosis (odds ratio [OR] = 2.561; 95% confidence interval [CI] = 1.100–5.965; P = 0.029), high-echo plaque (OR = 5.877; 95% CI = 1.472–23.462; P = 0.012), open-cell stent (OR = 3.173; 95% CI = 1.067–9.436; P = 0.038), and distal diameter of stent (OR = 1.541; 95% CI = 1.104–2.153; P = 0.011) were risk factors for postprocedural HD. The following factors were identified as risk factors for persistent hemodynamic depression: high-echo plaque (OR = 7.605; 95% CI = 2.105–27.468; P = 0.002) and open-cell stent (OR = 7.017; 95% CI = 1.384–35.583; P = 0.019); additionally, the further the minimum lumen distance from the carotid bifurcation, the lower the risk of persistent hemodynamic depression (OR = 0.942; 95% CI = 0.894–0.992; P = 0.024).</div></div><div><h3>Conclusions</h3><div>TS reduces the risk of postoperative HD and there is a trend toward a lower risk of ISR at 1 year after the procedure. Eccentric stenosis, high-echo plaque, open-cell stent, and distal diameter of stent are high-risk factors for HD.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123790"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426170","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":"The pivotal role of arachnoid-nerve conflict in trigeminal neuralgia without neurovascular conflict.","authors":"Hischam Bassiouni, Joelina Botsch, Saida Zouba","doi":"10.1016/j.wneu.2025.123888","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123888","url":null,"abstract":"<p><strong>Objectives: </strong>The etiology of trigeminal neuralgia (TN) without neurovascular conflict (NVC) is undetermined and classic neurovascular decompression procedures are not applicable. We analyzed a potential etiology in patients operated for TN without NVC.</p><p><strong>Material: </strong>Clinical, radiological and treatment outcome data were retrospectively reviewed in a consecutive cohort of 37 patients afflicted with medically intractable TN without detectable NVC on preoperative 3T-MRI nor during surgery. All patients underwent endoscopic-assisted microsurgical trigeminal nerve release from tethering arachnoid between January 2019 and December 2023. Intraoperative findings were compared to those of a control group of 22 patients undergoing surgery for other pathologies within the cerebellopontine angle (CPA).</p><p><strong>Results: </strong>Median age of the 24 women and 13 men with TN was 58 years (IQR 48-71). Mean preoperative pain intensity on the VAS scale and BNI was 9.5/10 and 5, respectively. Surgical exploration revealed an arachnoid-nerve conflict in all cases of TN (cohort group) and in only two patients of the control group (p<0.001). Release of the trigeminal nerve from its anchoring arachnoid yielded in significant postoperative improvement of VAS (1.6/10, p<0.001) and 84 % of the TN-patients achieved pain- and medication freedom (BNI 1) after a median postoperative follow-up of 24 months (IQR 7-46).</p><p><strong>Conclusions: </strong>An arachnoid-nerve conflict seems to play a pivotal role in the etiology of TN without NVC. Trigeminal nerve release from tethering arachnoid effectively achieves pain relief and medication independence.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123888"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630861","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":"Diagnostic Accuracy of a Deep Learning Algorithm for Detecting Unruptured Intracranial Aneurysms in Magnetic Resonance Angiography: A Multicenter Pivotal Trial","authors":"Wi-Sun Ryu ,&nbsp;Sungmoon Jeong ,&nbsp;Jaechan Park ,&nbsp;Dougho Park ,&nbsp;Heeyoung Kim ,&nbsp;Myungjae Lee ,&nbsp;Dongmin Kim ,&nbsp;Myungsoo Kim ,&nbsp;Byoung-joon Kim ,&nbsp;Hui Joong Lee","doi":"10.1016/j.wneu.2025.123882","DOIUrl":"10.1016/j.wneu.2025.123882","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial aneurysm rupture is associated with high mortality and disability rates. Early detection is crucial, but increasing diagnostic workloads place significant strain on radiologists. We evaluated the efficacy of a deep learning algorithm in detecting unruptured intracranial aneurysms (UIAs) using time-of-flight (TOF) magnetic resonance angiography (MRA).</div></div><div><h3>Methods</h3><div>Data from 675 participants (189 aneurysm-positive [221 UIAs] and 486 aneurysm-negative) were collected from 2 hospitals (2019–2023). Positive cases were confirmed by digital subtraction angiography, and images were annotated by vascular experts. The 3D U-Net-based model was trained on 988 nonoverlapped TOF MRA datasets and evaluated by patient- and lesion-level sensitivity, specificity, and false-positive rates.</div></div><div><h3>Results</h3><div>The mean age was 59.6 years (standard deviation 11.3), and 52.0% were female. The model achieved patient-level sensitivity of 95.2% and specificity of 80.5%, with lesion-level sensitivity of 89.6% and a false-positive rate of 0.19 per patient. Sensitivity by aneurysm size was 72.3% for lesions &lt;3 mm, 91.8% for 3–5 mm, and 94.3% for &gt;5 mm. Performance was consistent across institutions, with an area under the receiver operating characteristic curve of 0.949.</div></div><div><h3>Conclusions</h3><div>The software demonstrated high sensitivity and low false-positive rates for UIA detection in TOF MRA, suggesting its utility in reducing diagnostic errors and alleviating radiologist workload. Expert review remains essential, particularly for small or complex aneurysms.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123882"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630858","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":"Endovascular Therapy for Progressive Stroke due to Intracranial Atherosclerotic Large Vessel Occlusion Beyond the 24-Hour Time Window: A Single-Center Retrospective Cohort Study","authors":"Hanfeng Chen,&nbsp;Renjie Ji,&nbsp;Ziqi Xu,&nbsp;Yuan Fu","doi":"10.1016/j.wneu.2025.123799","DOIUrl":"10.1016/j.wneu.2025.123799","url":null,"abstract":"<div><h3>Background</h3><div>The optimal management for treating progressive strokes caused by anterior circulation intracranial atherosclerotic large vessel occlusion (ICAS-LVO) remains unclear.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on our stroke database. Among the patients presenting with mild ischemic stroke (National Institutes of Health Stroke Scale ≤5), 273 were diagnosed with anterior circulation ICAS-LVO. Forty-five patients who experienced neurologic deterioration (National Institutes of Health Stroke Scale increase ≥4) between 24 hours to 7 days poststroke, despite a persistent ischemic penumbra on computed tomography perfusion, were retrospectively identified. These patients were allocated to either the endovascular-therapy group or the medical-therapy group based on their receipt of endovascular intervention. The modified Rankin scale score at 90 days, the rate of technically successful recanalization, and perioperative complications were assessed.</div></div><div><h3>Results</h3><div>Of the 45 patients, 27 underwent endovascular therapy, and 18 received medical therapy. Recanalization was technically successful in all cases within the endovascular group. The preferred treatment was direct angioplasty, with 12 patients receiving balloon angioplasty alone, 11 receiving balloon angioplasty and stent implantation, and 4 undergoing balloon angioplasty followed by mechanical thrombectomy. The rate of functional independence (modified Rankin scale ≤2) at 90 days was significantly higher in the endovascular group (74.1%) compared to the medical group (33.3%, risk ratio 5.714; 95% confidence interval, 1.55 to 21.06; <em>P</em> = 0.007). The incidence of intracranial hemorrhage was slightly higher in the endovascular group, but not statistically significant.</div></div><div><h3>Conclusions</h3><div>Endovascular therapy may offer a viable treatment option for progressive stroke resulting from anterior circulation ICAS-LVO, even when the time from stroke onset to treatment exceeds 24 hours, in select patients.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123799"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459662","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 “Evaluating ChatGPT o1's Capabilities in Peripheral Nerve Surgery”","authors":"Hinpetch Daungsupawong ,&nbsp;Viroj Wiwanitkit","doi":"10.1016/j.wneu.2025.123805","DOIUrl":"10.1016/j.wneu.2025.123805","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123805"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473116","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":"Enabling technology with minimally invasive strategies: robot-assisted Cortical Bone Trajectory screws fixation in lateral transpsoas interbody fusion.","authors":"Nicola Marengo, Federico Pecoraro, Enrico Lo Bue, Stefano Colonna, Flavio Panico, Alberto Morello, Marco Ajello, Francesco Zenga, Diego Garbossa, Fabio Cofano","doi":"10.1016/j.wneu.2025.123890","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123890","url":null,"abstract":"<p><strong>Objectives: </strong>The robot-assisted cortical bone trajectory (CBT) screw placement is safer than the traditional fluoroscopy-assisted approach. This is the first technical note reporting a novel technique of robot-assisted CBT screws placement with a subfascial transmuscular approach.</p><p><strong>Technical note: </strong>After a lumbar interbody cage position, the second step consists in the robot-assisted placement of CBT screws in a prone position. A median skin incision is performed, ensuring an incision as small as possible. CBT screw direction and trajectory are planned on the sterile robot touchscreen display. A navigated drill is used to breach the cortical surface of the entry point. Then, a navigated drill bit is used to complete the exposure of the screw trajectory. The screw is placed with the support of the robotic arm. In the single-position the surgical field must be prepared since the first surgical step. All the navigation references are placed on the same iliac crest. The following steps resemble the ones described for the double-position.</p><p><strong>Conclusion: </strong>This is the first reported technical note about robot-assisted transmuscular CBT screw placement for posterior fixation in LLIF. The surgical technique proposed aims to combine the advantages of CBT screws and the use of innovative robot-assisted technology.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123890"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630860","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":"Otolaryngology-Assisted Approach for Anterior Cervical Discectomy and Fusion","authors":"M. Benjamin Larkin ,&nbsp;Anthony K. Allam ,&nbsp;Cyrus B. King ,&nbsp;N. Eddie Liou ,&nbsp;Alexander E. Ropper","doi":"10.1016/j.wneu.2025.123887","DOIUrl":"10.1016/j.wneu.2025.123887","url":null,"abstract":"<div><div>First introduced in 1955, anterior cervical discectomy and fusion (ACDF) surgery has seen minimal changes over the years. Its reproducibility, impressive long-term results, and minimal complication rates have established it as one of the most frequently performed cervical spinal fusion surgeries. Yet, postoperative dysphagia remains a concern with a 60% incidence rate. An otolaryngologist's expertise regarding cervical fascial anatomy can inform the spine surgeon's approach to an ACDF to potentially reduce postoperative dysphagia rates. We describe an illustrative case of a 35-year-old woman who presented with 8/10 neck and arm pain along with numbness in her fourth and fifth digits for the past 6 months despite multiple conservative treatments. Cervical spine magnetic resonance imaging demonstrated a large C6-7 central disc herniation resulting in severe foraminal stenosis and moderate C5-6 disc herniation. A C5-7 ACDF was performed. Successful ACDF can be performed using an otolaryngologist-assisted neck approach. Rather than opening the 3 layers of the deep cervical fascia individually and serially, the fascial layers were reflected medially by opening the carotid sheath, where the fascial layers coalesce, and performing the dissection to the spine in a lateral-to-medial fashion. This approach may help decrease rates of dysphagia.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123887"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626221","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}