World Neurosurgery: X最新文献

{"title":"A novel fish skin graft for dura repair: a comparative study in ovine","authors":"Hilmar Kjartansson ,&nbsp;Einar Teitur Björnsson ,&nbsp;Ingvar Hákon Ólafsson ,&nbsp;Sigurbergur Kárason ,&nbsp;Einar Jörundsson ,&nbsp;Eggert Gunnarsson ,&nbsp;Jan Saip Aunan-Diop ,&nbsp;Guðmundur Fertram Sigurjónsson","doi":"10.1016/j.wnsx.2025.100488","DOIUrl":"10.1016/j.wnsx.2025.100488","url":null,"abstract":"<div><h3>Background</h3><div>Closure of dura defects is crucial to maintain the functional abilities of the dura and prevent complications. Collagen-based grafts cause no strong foreign body reactions, being replaced by connective tissue over time. Collagen-based xenografts of bovine, porcine or equine origin are widely used but some have inherent religious barriers. The aim of this study was to assess the safety and efficacy of a collagen-based fish skin graft from Atlantic Cod for dura repair.</div></div><div><h3>Methods</h3><div>We compared an intact fish skin graft to an established bovine collagen graft for dura repair in 24 adult Icelandic domestic sheep. Bilateral frontoparietal craniotomies were performed with iatrogenic dura defects, applying the two grafts, one on each side. The animals were euthanized at given endpoints of either two, six, twelve or twenty weeks, and macroscopic and histological examination was performed.</div></div><div><h3>Results</h3><div>No animal died or had any neurological abnormalities, signs of infection, or cerebrospinal fluid leakage. Greater early inflammation with earlier graft organization was observed with the fish skin graft, and acceptable inflammatory reactions without foreign body reactions with both grafts at twenty weeks. Both grafts were fully absorbed, and the dura restored.</div></div><div><h3>Conclusions</h3><div>The intact fish skin graft is an ideal dural substitute, serving as a temporary anatomical barrier before fully degrading and promoting neodura formation. Standardizing the graft thickness could improve its efficacy. The graft is safe for use in dura repair and similarly effective as an established collagen graft. A human clinical trial is possible at this stage.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100488"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sympathetic intervention in abdominopelvic cancer pain: A systematic review and meta-analysis","authors":"Made Agus Mahendra Inggas ,&nbsp;Fandi Hendrawan ,&nbsp;Amelia Marcelina ,&nbsp;Kezia Aurelia Tamzil ,&nbsp;Takaomi Taira","doi":"10.1016/j.wnsx.2025.100486","DOIUrl":"10.1016/j.wnsx.2025.100486","url":null,"abstract":"<div><div>This review aims to investigate the effectiveness of CP, SHP, and GI intervention as a singular or combination to reduce the pain intensity. Medline, Scopus, and CENTRAL databases were used to identify abstracts using predefined search terms. Risk of bias in non-randomized studies - of intervention tool and Cochrane risk-of-bias tool for randomized trials were applied for risk of bias assessment. This review includes only severe pain defined as visual analogue scale or numeric rating scale (NRS) 7–10. Fifteen articles were included in this study. In general, pain intensity was reduced significantly after the intervention (MD -4.58; 95 %CI -5.25 to −3.91). However, subgroup analysis failed to identify any significant reduction in ganglion Impar group. Regarding morphine consumption, the intervention was significantly subsided the need of morphine (SMD -1.31; 95 %CI -1.86 to −0.76). In meta-regression, follow-up period was significantly moderated the pain changes by increasing 0.43 score within a month after the intervention (<em>p value</em> &lt; 0.01). The limitation of this study lies on the pain assessment that used NRS which is a self-reported evaluation and may lead to self-reported bias. In conclusion, the sympathetic intervention demonstrates its effectiveness in cancer pain. However, since GI intervention mostly failed to reduce the pain severity during the follow up, GI intervention should be used in combination with another intervention.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100486"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obstructed foramina of Monro, cerebral aqueduct, 3rd or 4th ventricles are reliable predictors of hydrocephalus in hemorrhagic stroke patients","authors":"Petra Octavian Perdana Wahjoepramono ,&nbsp;Aloysius Bagus Sasongko ,&nbsp;Danny Halim ,&nbsp;Kurnia Wahyudi ,&nbsp;Abrar Arham ,&nbsp;Achmad Adam ,&nbsp;Yeo Tseng Tsai ,&nbsp;Eka Julianta Wahjoepramono ,&nbsp;Julius July ,&nbsp;Tri Hanggono Achmad","doi":"10.1016/j.wnsx.2025.100487","DOIUrl":"10.1016/j.wnsx.2025.100487","url":null,"abstract":"<div><h3>Objective</h3><div>Hydrocephalus is a potential consequence of intracerebral hemorrhage with ventricular extension (ICH+IVH) and is independently associated with poorer prognosis. This study evaluated the modified Graeb (mGraeb) score as a predictor of hydrocephalus and proposed an alternative assessment method by analyzing the obstruction of the foramina of Monro, cerebral aqueduct, and the 3rd or 4th ventricles as sole predictors of hydrocephalus in ICH+IVH patients.</div></div><div><h3>Methods</h3><div>This retrospective study included adult spontaneous ICH+IVH patients admitted to the National Brain Center and Siloam Hospital, Indonesia, between 2018 and 2023. Clinical information and imaging data were evaluated. Statistical analyses examined the correlation between hydrocephalus incidence and mGraeb score or obstruction of ventricular choke points. Tandem testing was performed to compare the two methods.</div></div><div><h3>Results</h3><div>One hundred and nineteen patients were included in this study. Hydrocephalus was diagnosed in 84 patients (70.6 %). mGraeb score (<em>p</em> &lt; 0.001), obstructed foramina of Monro (<em>p</em> &lt; 0.001), cerebral aqueduct (<em>p</em> &lt; 0.001), 3rd ventricle (<em>p</em> = 0.002), 4th ventricle (<em>p</em> = 0.002), and any choke points (<em>p</em> &lt; 0.001) are significantly associated with the incidence of hydrocephalus. Tandem testing suggested that choke point obstructions are more sensitive (<em>p</em> &lt; 0.001), yet less specific (<em>p</em> = 0.004) in predicting hydrocephalus compared to the mGraeb score.</div></div><div><h3>Conclusion</h3><div>Both the mGraeb system and evaluating ventricular choke points are reliable predictors of hydrocephalus in ICH+IVH patients. Evaluating obstructions of the ventricular choke points is simpler and easier to be performed in clinical settings compared to the mGraeb score.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100487"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of peripheral nerve injury outcomes between COVID-19 survivors and non-COVID rehabilitation inpatients: A retrospective study","authors":"Antonio Mondríguez-González ,&nbsp;Brian M. Rothemich ,&nbsp;Manasi Sheth ,&nbsp;Kevin N. Swong ,&nbsp;Colin K. Franz","doi":"10.1016/j.wnsx.2025.100481","DOIUrl":"10.1016/j.wnsx.2025.100481","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral nerve injury (PNI) is associated with severe Coronavirus disease 2019 (COVID-19) survivorship. A physiatrist often diagnoses PNI during a detailed functional assessment during an inpatient rehabilitation stay. COVID-19 patients have elevated rates of medical comorbidities, including risk factors for acquired PNI, such as diabetes mellitus and obesity. It is unknown if the functional prognosis from PNI in COVID-19 survivors differs substantially from PNI in other inpatient rehabilitation populations.</div></div><div><h3>Methods</h3><div>This retrospective chart review study aimed to determine the prognosis of severe COVID-19 survivorship-associated PNI and compare it to PNI associated with other inpatient rehabilitation populations. The primary outcome was the change in manual muscle testing (MMT) over time. Secondary outcomes included the rate of peripheral nerve surgery and the number of distinct PNI sites per patient.</div></div><div><h3>Results</h3><div>The analysis consisted of 60 subjects with PNI. Thirty subjects with PNI associated with COVID-19 were matched with 30 subjects with non-COVID-19 associated PNI who were diagnosed during their inpatient rehabilitation admission. The data collected included basic demographics, COVID-19 status immediately before inpatient rehabilitation admission, medical comorbidities, acute rehabilitation inpatient diagnosis, nerve injury location and mechanism of injury, muscles affected, serial MMT change, and surgical intervention documentation. No significant difference was found between the improvement of MMT, surgery rate, or number of nerve injuries and COVID-19 status.</div></div><div><h3>Conclusion</h3><div>PNIs associated with severe COVID-19 survivorship have similar recovery patterns as those of other etiologies. This data is reassuring that PNI associated with COVID-19 may be managed similarly to other types of PNI.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100481"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From hospital discharge to long-term care: Unmet rehabilitation needs in cauda equina syndrome patients from a national UK cohort","authors":"Holly Roy ,&nbsp;Krithika Anil ,&nbsp;Jack Read ,&nbsp;Marcus J. Drake ,&nbsp;Ingrid Hoeritzauer ,&nbsp;Julie Woodfield ,&nbsp;UCES Collaborators ,&nbsp;British Neurosurgical Trainee Research Collaborative","doi":"10.1016/j.wnsx.2025.100485","DOIUrl":"10.1016/j.wnsx.2025.100485","url":null,"abstract":"<div><h3>Objectives</h3><div>Although long term disability may be a consequence of cauda equina syndrome (CES), the evidence base for the effect of rehabilitation or different rehabilitation strategies is lacking. Our aim was to understand long term neurological deficits (understood as rehabilitation needs) and current rehabilitation provision for patients with CES.</div></div><div><h3>Methods</h3><div>We retrospectively analysed data from a large UK wide cohort of CES patients presenting between 1st June 2018 and 31st May 2019. Rehabilitation referrals and attendance were described, and symptoms at discharge and one year were identified as potential targets for rehabilitation.</div></div><div><h3>Results</h3><div>Physiotherapy was the most common inpatient rehabilitation service accessed following surgery for CES (572/610, 94%). Few patients were referred to specialist spinal rehabilitation services at discharge (49/608, 8%). At one year follow up there were high rates of residual symptoms (motor (66%), bladder (20%), bowel (17%), and sexual dysfunction (13%)). There was a significantly higher level of ongoing bladder dysfunction in females (27%) compared with males (11%) despite similar levels at presentation (females 84% vs males 82%).</div></div><div><h3>Conclusion</h3><div>Referral to specialist spinal rehabilitation following CES surgery is not routine in the UK but a notable proportion of patients have ongoing symptoms at one year following surgical decompression. Prospective studies of rehabilitation strategies following surgery for CES are needed to guide treatment decisions and optimise post-surgical outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100485"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of postoperative vascularization between collagen matrix duraplasty and conventional duraplasty after direct bypass surgery in Moyamoya disease: A single-institute retrospective cohort study","authors":"Izumi Yamaguchi,&nbsp;Yasuhisa Kanematsu,&nbsp;Kenji Shimada,&nbsp;Masaaki Korai,&nbsp;Takeshi Miyamoto,&nbsp;Shu Sogabe,&nbsp;Manabu Ishihara,&nbsp;Tatsuya Haboshi,&nbsp;Yasushi Takagi","doi":"10.1016/j.wnsx.2025.100483","DOIUrl":"10.1016/j.wnsx.2025.100483","url":null,"abstract":"<div><h3>Background</h3><div>Moyamoya disease (MMD) is characterized by the development of collateral circulation through the dura mater and overexpression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFBGF). Type 1 collagen promotes VEGF- and bFBGF-dependent neovascularization. The usefulness of collagen matrix duraplasty has not been investigated in MMD, particularly regarding vascularization. The present retrospective study aimed to assess whether collagen matrix duraplasty enhances the postoperative vascularization in adult-onset MMD.</div></div><div><h3>Methods</h3><div>Twenty-six patients (40 bypasses) who underwent direct bypass surgery for adult-onset MMD were included. The patients were categorized into a collagen matrix group (CMG; <em>n</em> = 17 [25 bypasses]) and a control group (CG; <em>n</em> = 9 [15 bypasses]). We compared postoperative vascularization with cerebral angiography, single-photon emission computed tomography (SPECT), and stroke-free survival.</div></div><div><h3>Results</h3><div>The direct bypass was patent in 92 % of CMG and 86.7 % of CG, with no significant difference (<em>p</em> = 0.623). Middle meningeal artery blush was observed in 76 % of CMG and 80 % of CG, indicating similar development (<em>p</em> &gt; 0.99). Matsushima angiographic grade was comparable between groups (good: CMG 20 %, CG 6.7 %; fair: CMG 72 %, CG 80 %; poor: CMG 8 %, CG 13.3 %), with no significant differences. The median relative cerebral blood flow significantly increased postoperatively in CMG (preoperative 0.85, postoperative 0.94; <em>p</em> = 0.009) but not in CG (preoperative 0.93, postoperative 0.94; <em>p</em> = 0.455). The two-year stroke-free survival based on duraplasty showed no significant difference (<em>p</em> = 0.726) between groups.</div></div><div><h3>Conclusions</h3><div>Collagen matrix duraplasty does not enhance the postoperative vascularization status after direct bypass surgery in adult-onset MMD in the short term.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100483"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of anticoagulation with apixaban following acute traumatic brain injury: A case series","authors":"Abhishek R. Mogili ,&nbsp;Rodnell Busigó-Torres ,&nbsp;Pemla Jagtiani ,&nbsp;Bashar Zaidat ,&nbsp;Jueria Rahman ,&nbsp;Thomas Fetherston ,&nbsp;Salazar A. Jones ,&nbsp;Laura Salgado-Lopez ,&nbsp;Zachary L. Hickman","doi":"10.1016/j.wnsx.2025.100484","DOIUrl":"10.1016/j.wnsx.2025.100484","url":null,"abstract":"<div><h3>Background</h3><div>The rise in traumatic brain injuries (TBI) among geriatric patients, often using direct oral anticoagulants (DOACs), underscores the urgency to explore safe resumption of these medications post-injury. DOAC use confers an increased risk of hemorrhage and mortality following TBI. This study focuses on the use of apixaban following acute TBI, addressing the paucity of data and guidelines on anticoagulation management in this population.</div></div><div><h3>Methods</h3><div>A retrospective review of TBI patients admitted to NYC Health + Hospitals/Elmhurst, was conducted from April 2016 to December 2021. Inclusion criteria included age ≥18, a TBI with a head abbreviated injury score (AIS-Head) ≥2, a positive head computed tomography (CT) scan, and apixaban initiated or resumed after TBI. Head CT images were collected at four time points: initial, stability, pre-apixaban, and last follow-up.</div></div><div><h3>Results</h3><div>10 patients were included. Median age was 72 ± 10.5 years, median Glasgow Coma Scale (GCS) score and AIS-Head scores were 14 ± 1 and 3 ± 1 respectively. Apixaban was initiated a median of 9 ± 6 days following the first stable head CT. The median radiological follow-up was 35.5 ± 19.5 days after starting apixaban. No patient had a new or worsening intracranial hemorrhage or unexpected need for neurosurgical intervention following initiation of apixaban. Two patients expired after prolonged hospitalizations from medical complications secondary to their trauma and unrelated to apixaban.</div></div><div><h3>Conclusions</h3><div>Our results suggest that starting or resuming apixaban relatively early is likely safe in selected TBI patients following a stable head CT and with no anticipated imminent need for invasive neurosurgical procedures. Further studies are warranted to confirm these results and refine the optimal timing for initiating apixaban after TBI.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100484"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144296845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical appraisal of 'exoscope-assisted spine surgery: Current applications and future directions': Addressing methodological and interpretational limitations","authors":"Hamza Zaheer ,&nbsp;Muhammad Hammad Zaheer ,&nbsp;Zain Mazhar","doi":"10.1016/j.wnsx.2025.100482","DOIUrl":"10.1016/j.wnsx.2025.100482","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100482"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144221813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of prototyped molds for cranioplasty using desktop 3D printers: A single-center experience","authors":"Eduardo Burkot Hungria ,&nbsp;Lorena Maria Dering ,&nbsp;Maria Eduarda Rizzardi de Lima ,&nbsp;Matheus Kahakura Franco Pedro ,&nbsp;André Giacomelli Leal","doi":"10.1016/j.wnsx.2025.100479","DOIUrl":"10.1016/j.wnsx.2025.100479","url":null,"abstract":"<div><h3>Introduction</h3><div>Cranioplasty is one of the most commonly performed neurosurgical procedures worldwide. When an autologous bone fragment is unavailable, reconstruction is often carried out using biocompatible materials such as polymethylmethacrylate (PMMA). 3D printing has emerged as an effective alternative, enabling the creation of molds for shaping PMMA implants during surgery. However, the high cost of outsourced molds has prompted the exploration of desktop 3D printers as a viable, low-cost solution.</div></div><div><h3>Methods</h3><div>This study demonstrates the additive manufacturing process of molds for cranioplasty using desktop 3D printers. Computed tomography images were processed with specialized software to create two mold components, which were subsequently manufactured using 3D printers. The molds were utilized for implant fabrication in 35 surgeries.</div></div><div><h3>Results</h3><div>Of the 35 cranioplasties, 7 patients (20 %) required reoperation due to epidural empyema (1), brain abscess (1), serosanguinous rhinorrhea (1), implant defect (1), and suture dehiscence (3). Plate removal was needed in only 4 cases (11.43 %). The average mold cost, including segmentation, modeling, slicing, printing, and post-processing, was $100.00. All molds were successfully used.</div></div><div><h3>Conclusion</h3><div>The results indicate that the use of 3D-printed molds is a feasible, accessible, and safe approach, yielding favorable clinical and aesthetic outcomes, with a complication rate consistent with the literature. This research emphasizes the importance of collaboration between neurosurgeons and 3D printing specialists, suggesting that effective communication between teams is crucial for optimizing the use of this technology.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100479"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pneumatic leg compression-induced changes in cardiac output predict fluid responsiveness in traumatic brain injury and post-operative neurosurgery with septic shock","authors":"Panu Boontoterm ,&nbsp;Siraruj Sakoolnamarka ,&nbsp;Karanarak Urasyanandana ,&nbsp;Pusit Fuengfoo","doi":"10.1016/j.wnsx.2025.100480","DOIUrl":"10.1016/j.wnsx.2025.100480","url":null,"abstract":"<div><h3>Objectives</h3><div>To assess whether hemodynamic changes induced by pneumatic leg compression (PLC) can predict fluid responsiveness in patients with traumatic brain injury and post-operative neurosurgical patients with septic shock.</div></div><div><h3>Methods</h3><div>Patients were categorized into two groups based on their response to a 500 mL crystalloid fluid bolus: the fluid responder group (increase in stroke volume [SV] &gt;10 % from baseline) and the fluid non-responder group (increase in SV ≤ 10 %). Hemodynamic variables cardiac output (CO) and SV were measured using esophageal Doppler at four time points: (1) pre-PLC, (2) post-PLC, (3) pre-fluid bolus, and (4) post-fluid bolus. Percent changes in SV and CO following PLC were compared between groups. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC) analysis.</div></div><div><h3>Results</h3><div>Following PLC, the fluid responder group demonstrated significantly greater increases in both SV and CO compared to the non-responder group. A post-PLC SV change ≥3.5 % predicted fluid responsiveness with a sensitivity of 88.2 % and specificity of 87.5 % (AUC = 0.90, <em>p</em> = 0.01). In contrast, a post-PLC CO change ≥5.4 % had a sensitivity of 64.7 % and specificity of 87.5 % (AUC = 0.787, <em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>PLC-induced changes in SV, and to a lesser extent CO, are promising dynamic parameters for predicting fluid responsiveness in postoperative neurosurgical patients requiring neurocritical care and presenting with septic shock. This approach may offer a safe, non-invasive alternative to traditional fluid challenges, particularly in patient sample at risk for intracranial hypertension.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100480"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144169458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}