World Neurosurgery: X最新文献

{"title":"Stereotactic radiosurgery for hepatitis C virus-related hepatocellular carcinoma brain metastasis: A retrospective analysis and systematic review","authors":"Muhammad Izhar , Yusuke S. Hori , Ahed H. Kattaa , Fred C. Lam , Neeraj Kalra , Nirmeen Zagzoog , Armine Tayag , Louisa Ustrzynski , Sara C. Emrich , Erqi L. Pollom , Scott G. Soltys , Melanie Hayden Gephart , David J. Park , Steven D. Chang","doi":"10.1016/j.wnsx.2025.100541","DOIUrl":"10.1016/j.wnsx.2025.100541","url":null,"abstract":"<div><h3>Background</h3><div>Brain metastases (BM) from hepatocellular carcinoma (HCC) are rare and typically associated with poor prognosis. While whole-brain radiotherapy (WBRT) and surgical resection have been used for treatment, their applicability is often limited due to hepatic dysfunction and associated comorbidities. Stereotactic radiosurgery (SRS) offers a less invasive, targeted approach, but its role in HCC-related BM, especially in the context of hepatitis C virus (HCV) infection, remains unclear.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated patients with BM secondary to HCV-related HCC who were treated with SRS. Treatment parameters, including prescribed radiation dose, local tumor control (LTC), radiological response, and overall survival (OS), were assessed. Tumor control was defined based on radiological response to CyberKnife (CK) SRS as a complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) per response evaluation criteria in solid tumors (RECIST) guidelines. Moreover, we conducted a systematic review in accordance with PRISMA using three databases: PubMed/MEDLINE, Embase, and Web of Science.</div></div><div><h3>Results</h3><div>This is the first study to report outcomes of SRS specifically in patients with BM from HCV-related HCC. A total of 3 patients with a total number of 7 lesions were treated with a median prescribed dose of 27 Gy (range: 20–30 Gy). All treated lesions achieved 100 % LTC at 3-month, 6-month, and final follow-up evaluations, with no evidence of local progression. Radiologic assessment showed complete response in 14.3 % of lesions, partial response in 28.6 %, and stable disease in 57.1 %, with no cases of progressive disease. The mean overall survival was 8 months, falling within the upper range of previously reported survival (4–20 weeks) in HCC BM patient populations. For the systematic review, a total of 98 studies were initially identified through database searches. Following the removal of 8 duplicate entries, 90 studies were screened by title and abstract, resulting in 9 studies for full-text assessment. Of these, 3 were excluded for not meeting the inclusion criteria. Ultimately, 6 studies were included in the final systematic review. According to the systematic review, treatment was most commonly performed with Gamma Knife radiosurgery, with marginal doses ranging from 10 to 32 Gy delivered at the 50 % isodose line. Tumor volumes varied significantly (0.01–67.3 cm<sup>3</sup>), and hemorrhagic presentation was frequent, occurring in up to 76 % of cases. Reported overall survival (OS) ranged from 2 to 47 weeks. SRS-related complications were generally minimal. However, the existing literature is limited by heterogeneity and inconsistent evaluation of key prognostic factors.</div></div><div><h3>Conclusion</h3><div>SRS is a safe and effective treatment for BM in patients with HCV-related HCC, offering excellent local control. Given the rar","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100541"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320242","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":"Occipital transtentorial approach for posterior cranial fossa lesions located away from the midsagittal plane: A technical note","authors":"Hideo Ohba ,&nbsp;Toshiyuki Tsuboi ,&nbsp;Yuko Miyazaki ,&nbsp;Yosuke Kajihara ,&nbsp;Shigeyuki Sakamoto ,&nbsp;Kazutoshi Mukada ,&nbsp;Shinji Ohba","doi":"10.1016/j.wnsx.2025.100493","DOIUrl":"10.1016/j.wnsx.2025.100493","url":null,"abstract":"<div><h3>Background</h3><div>The occipital transtentorial approach (OTA) is a well-established technique for accessing lesions in the pineal region, posterior third ventricle, and dorsal midbrain. Compared to the supracerebellar infratentorial approach, OTA provides superior visualization without cerebellar obstruction. However, its application to posterior cranial fossa lesions located away from the midsagittal plane remains underexplored, and its lateral limitations have not been clearly defined.</div></div><div><h3>Case presentation</h3><div>A 65-year-old woman with a symptomatic cerebellar tentorial meningioma located away from the midsagittal plane underwent tumor resection via OTA. A stepwise cerebrospinal fluid drainage strategy was employed to minimize brain retraction and optimize surgical exposure. The craniotomy extended across the superior sagittal and transverse sinuses to maximize visualization. The cranial limit was defined by the ascending vein joining the superior sagittal sinus, while the lateral limit was delineated by the confluence of the Vein of Labbé with the transverse sinus. No postoperative complications or permanent neurological deficits were observed.</div></div><div><h3>Discussion</h3><div>A literature review revealed a lack of detailed reports on OTA for posterior fossa lesions located away from the midsagittal plane. We propose that the Vein of Labbé serves as a key anatomical landmark defining the lateral boundary of OTA. Embryological evidence further supports its validity as an anatomical constraint.</div></div><div><h3>Conclusion</h3><div>This report provides a detailed description of OTA for posterior fossa lesions located away from the midsagittal plane. Our findings highlight the importance of the Vein of Labbé as a lateral boundary, necessitating further case accumulation and comparative studies to refine OTA indications.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100493"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680471","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":"Potential use of decorin in preventing cerebral vasospasm through the inhibition of transforming growth factor-beta activity: Insights from an experimental rabbit subarachnoid hemorrhage model","authors":"Betul Yaman ,&nbsp;Gulce Gel ,&nbsp;Cengiz Tuncer ,&nbsp;Sahin Hanalioglu ,&nbsp;Husamettin Bulut ,&nbsp;Ata Turker Arikok ,&nbsp;Bora Gurer ,&nbsp;Erhan Turkoglu","doi":"10.1016/j.wnsx.2025.100520","DOIUrl":"10.1016/j.wnsx.2025.100520","url":null,"abstract":"<div><h3>Objective</h3><div>The development of vasospasm after subarachnoid hemorrhage (SAH) is a major cause of death and disability. It leads to structural changes such as smooth muscle and myofibroblast proliferation, necrosis, intimal hyperplasia, and vascular fibrosis. Transforming growth factor-beta1 (TGF-β1) activates nonmuscular myofibroblasts, promoting cerebral vasoconstriction. Decorin, a natural TGF-β inhibitor, has not yet been evaluated for its potential to prevent SAH-induced vasospasm. This study aimed to investigate the effects of decorin on cerebral vasculopathy and hippocampal injury in a rabbit model of TGF-β-induced vasospasm.</div></div><div><h3>Methods</h3><div>Thirty-two male New Zealand white rabbits (2.5–4 kg) were randomly assigned to four groups: control, SAH, decorin, and TGF-β1. Except for the control group, all underwent the SAH procedure. The decorin group received 100 μg/kg decorin intraperitoneally for 3 days; the TGF-β1 group received 50 μg TGF-β1 intracisternally in 1 cc autologous CSF. Animals were sacrificed at 72 h using perfusion–fixation. Basilar artery cross-sectional area, wall thickness, and hippocampal degeneration scores were assessed using histopathological and statistical analysis systems.</div></div><div><h3>Results</h3><div>Based on statistical analyses, decorin treatment significantly increased the cross-sectional area of the basilar artery but significantly reduced the wall thicknesses compared with those in the SAH and TGF-β1 groups. Furthermore, hippocampal neuronal degeneration scores were significantly lower in the decorin and control groups than in the SAH and TGF-β1 groups. There were no significant differences between the groups in terms of proliferating cell nuclear antigen.</div></div><div><h3>Conclusion</h3><div>Decorin treatment in rabbits with experimentally induced SAH ameliorated TGF-β1-induced vasospasm, cerebral vasculopathy associated with vascular wall fibrosis, and subsequent decreased vessel wall thickness.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100520"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095023","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":"Assessment of cognitive dysfunction in patients with temporal contusions undergoing surgical evacuation","authors":"Sebastián Ordoñez-Cure ,&nbsp;Lina M. Villegas-Trujillo ,&nbsp;Carlos A. Hurtado-González ,&nbsp;Sebastián Ospina-Otálvaro ,&nbsp;César O. Quintero-Moreno ,&nbsp;Santiago J. González-Daza ,&nbsp;Juan F. Ayala-Rico ,&nbsp;Óscar A. Escobar-Vidarte","doi":"10.1016/j.wnsx.2025.100516","DOIUrl":"10.1016/j.wnsx.2025.100516","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic brain injury (TBI) is a leading cause of death and disability, with cognitive sequelae affecting over six million people annually. These impairments can affect the patients social, familial, and work-related relationships, as well as their overall quality of life. This study aimed to identify cognitive dysfunction patterns in patients with temporal contusions requiring surgical drainage and assess their functional outcomes.</div></div><div><h3>Methods</h3><div>This cross-sectional cohort study was conducted at Hospital Universitario del Valle, Cali, Colombia, involving TBI patients with temporal contusions who underwent surgical drainage (craniectomy or craniotomy) between 2018 and 2022. Eligibility criteria included patients aged 15–70 requiring surgery, who underwent neuropsychological evaluation at least six months post-surgery. Exclusion criteria included vegetative state, lack of informed consent, and prior psychiatric disorders.</div></div><div><h3>Results</h3><div>The TBI group showed significant cognitive impairments, particularly in executive functions, memory, and language processing. Statistically significant differences were found in MoCA, FAB, Digit Span, and Boston Naming Test (<em>p</em> &lt; 0.001). Three neurocognitive clusters were identified: Cluster 1 had deficits in memory, language, and executive functions; Cluster 2 showed high mental health scores according to the GHQ-28 test and moderate working memory performance; Cluster 3 exhibited enhanced cognitive abilities and attained low scores on the GHQ-28, indicating a favorable psychological well-being profile.</div></div><div><h3>Conclusions</h3><div>TBI patients with temporal contusions requiring surgical drainage exhibit significant cognitive dysfunction, particularly in executive functions, memory, and language. Individualized rehabilitation strategies are needed, and further research should focus on larger samples and more specific neurocognitive testing.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100516"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004115","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":"Structural and compensatory trends in spinopelvic parameters of lumbosacral transitional vertebrae: A retrospective cohort analysis","authors":"Nikita Das ,&nbsp;Ravi Dhamija ,&nbsp;Orlando Martinez ,&nbsp;John Francis ,&nbsp;Rohit Mauria ,&nbsp;Collin M. Labak ,&nbsp;Eric Z. Herring ,&nbsp;Gabriel Smith","doi":"10.1016/j.wnsx.2025.100492","DOIUrl":"10.1016/j.wnsx.2025.100492","url":null,"abstract":"<div><h3>Objective</h3><div>Lumbosacral transitional vertebrae (LSTV) are an underdiagnosed source of low back pain (LBP), or Bertolotti Syndrome. This study identifies trends in radiographic lumbo–pelvic parameters among LSTV patients that may serve as prognostic indicators for surgery.</div></div><div><h3>Methods</h3><div>A retrospective chart review identified LSTV patients using a free-text search of our institution's electronic medical record for terms related to “LSTV” and \"Bertolotti.\" Patients lacking radiographic evidence of abnormal fusion between L5 and the sacrum/ilium were excluded. Clinical features and spinopelvic parameters, including lumbar lordosis (LL), pelvic incidence (PI), and pelvic tilt (PT) were analyzed.</div></div><div><h3>Results</h3><div>Of 122 LSTV patients, 108 (88.5 %) had LBP consistent with Bertolotti Syndrome. Median L4-L5 lordosis was 17.9° [16.9°, 18.9°], L5-S1 lordosis was 15.2° [14.2°, 16.2°]. Median PI was 65.7° [63.4°, 67.9°], with a PI-LL mismatch of 8.4° [6.1°, 10.7°]. Median PT was estimated at 25.1° [23.3°, 26.9°]. Significant associations existed between pain severity and PT &gt; 35° (<em>p</em> = 0.004), as well as increased PI (<em>p</em> = 0.03). Castellvi Type II LSTV patients were more likely to have an L5/S1 angle &gt;15° (<em>p</em> = 0.02).</div></div><div><h3>Conclusions</h3><div>This study aims to improve and understand the impact of spinopelvic parameters for patients with LSTV. Elevated Pelvic Tilt and Pelvic Incidence are associated with increased risk of LSTV manifesting as Bertolotti Syndrome. Additionally, the lumbosacral transition may not be located at L5/S1 in these patients. Development of algorithm-based technologies that identify LSTV radiographically and measure corresponding spinopelvic parameters using standardized protocols may facilitate improvements in care for this patient population.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100492"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666031","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":"Applications of focused ultrasound for spinal disorders and beyond: Advances and future prospects – a narrative review","authors":"Muhammad Ammar Haider ,&nbsp;Ysmeen Tariq Bucklain ,&nbsp;Zainab Aslam ,&nbsp;Santiago Pastrana-Brandes ,&nbsp;Michelle Ennabe ,&nbsp;Albert Alan ,&nbsp;Martin Weinand","doi":"10.1016/j.wnsx.2025.100512","DOIUrl":"10.1016/j.wnsx.2025.100512","url":null,"abstract":"<div><div>Ultrasound technology is a cornerstone of diagnostic medicine throughout the world. Equally noteworthy is its utility in therapeutics, leveraging the precise deposition of ultrasound energy within diverse tissues for a growing spectrum of therapeutic effects. It is in the interest of neurosurgeons — especially those managing patients with spine-specific morbidities such as back pain and motor disorders — to understand the basis and examples of such use. While transcranial focused ultrasound (tcFUS) dominates research and trials, both clinical interest and research in transpinal FUS may upend spine care from minimally to non-invasive. Although challenges both technical and specific to the spine exist, overcoming them will optimize integration into clinical practice.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100512"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018875","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":"Stereotactic radiosurgery for brain metastases from non-uterine Leiomyosarcoma: A retrospective case series","authors":"Juan J. Cardona,&nbsp;Yusuke S. Hori,&nbsp;Ahed H. Kattaa,&nbsp;Paul M. Harary,&nbsp;Fred C. Lam,&nbsp;Deya Abu-Reesh,&nbsp;Louisa Ustrzynski,&nbsp;Sara C. Emrich,&nbsp;Armine Tayag,&nbsp;Melanie Hayden-Gephart,&nbsp;David J. Park,&nbsp;Steven D. Chang","doi":"10.1016/j.wnsx.2025.100517","DOIUrl":"10.1016/j.wnsx.2025.100517","url":null,"abstract":"<div><h3>Purpose</h3><div>Leiomyosarcoma (LMS) is a rare malignant mesenchymal cancer derived from smooth muscle cells. The estimated incidence of brain metastases (BM) from uterine LMS ranges between 0.058 and 0.128 per 100,000 women. Moreover, studies focused on non-uterine LMS BM, and their management are scant. Herein, we determined the efficacy and safety of stereotactic radiosurgery (SRS) for the treatment of patients with BM secondary to non-uterine LMS.</div></div><div><h3>Methods</h3><div>We identified patients with BM from non-uterine LMS who underwent CyberKnife (CK) SRS treatment. Patient, lesion, treatment, and outcome data were documented. The radiological response was evaluated per RECIST guidelines. Statistical analysis included Kaplan–Meier survival estimates and descriptive statistics.</div></div><div><h3>Results</h3><div>This study included 16 tumors found in four patients (mean age: 57 ± 17.9 years) with a mean overall survival of 14 months (95 % CI: 5.88–22.12 months). The lesions were located predominantly in the supratentorial region (62.5 %). The median lesion volume was 1.89 cm³, with most lesions treated in a single fraction (87.5 %) using a median dose of 20 Gy. At 3- and 6-month follow-ups, complete or partial responses were observed in 75 % of lesions, with local progression-free survival (PFS) rates of 100 % at 3 months and 75 % at 6 and 12 months. Only one lesion showed progression, consistent with radiation necrosis.</div></div><div><h3>Conclusions</h3><div>Prior studies focused on uterine LMS BM alone or lacked tumor site stratification. Our study, the largest on non-uterine LMS BM, is the first to assess CK SRS as a standalone treatment, demonstrating its efficacy in local tumor control and PFS.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100517"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043922","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":"Postoperative sagittal alignment measurements independently predict clinical outcomes after anterior cervical discectomy with anterior or circumferential fusion","authors":"Daniele Armocida ,&nbsp;Giuseppa Zancana ,&nbsp;Antonio Sportelli ,&nbsp;Fabio Cofano ,&nbsp;Diego Garbossa ,&nbsp;Alessandro Frati","doi":"10.1016/j.wnsx.2025.100515","DOIUrl":"10.1016/j.wnsx.2025.100515","url":null,"abstract":"<div><h3>Background</h3><div>Several studies have reported the impact of cervical sagittal alignment on surgical outcomes, with limited results. The primary objective of this study is to determine whether postoperative cervical sagittal balance is an independent predictor of health-related quality of life outcomes after anterior cervical discectomy (ACD) with anterior or circumferential fusion.</div></div><div><h3>Methods</h3><div>A retrospective observational study on a cohort of 91 patients undergoing ACD was examined. Preoperative and postoperative cervical lordotic angle, C2, C7, T1, Occipital slope and C2-C7 sagittal vertical axis (SVA) was measured on standing lateral cervical spine radiographs. Outcome was assessed with 3 disease-specific measures: post-operative recurrent neck pain, complete functional recovery (NDI = 0–20 %) and the patient's self-reported limitation of neck mobility. Clinical data, level of disease, presence of myelopathy, and surgical technique were evaluated in a multivariate analysis.</div></div><div><h3>Results</h3><div>C2-C7 SVA values exhibited the greatest variability among the treated cases. The postoperative change in C2-C7 SVA, demonstrated a significant distinction between subjects who experienced complete recovery for all the three outcome items at the end of follow-up (<em>t</em>-test: <em>p</em> test: <em>p</em> = 0.050.05). Low C2-C7 SVA values showed a positive correlation with the patient's functional recovery time (<em>p</em> = 0.03) and time to postoperative pain relapse (<em>p</em> = 0.04).</div></div><div><h3>Conclusion</h3><div>This study emphasizes the importance of considering postoperative sagittal alignment measurements in assessing patient outcomes after ACD surgery and fusion. <em>L</em>ow C2-C7 SVA values (less than 30 mm) were indicative of shorter recovery times and improved outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100515"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043921","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":"Determinant of choice of health care providers among the general population, a cross-sectional study from Saudi Arabia","authors":"Ryan D. Alghamdi ,&nbsp;Albandari S. Baatiyah ,&nbsp;Ahmed Z. Awan ,&nbsp;Fawaz M. Alhalafi ,&nbsp;Aroob A. Jaad ,&nbsp;Abdulaziz A. Alzahrani ,&nbsp;Rakan Farouk Y. Bokhari ,&nbsp;Abdulrahman J. Sabbagh","doi":"10.1016/j.wnsx.2025.100532","DOIUrl":"10.1016/j.wnsx.2025.100532","url":null,"abstract":"<div><h3>Background</h3><div>Patients’ choices in selecting healthcare providers are increasingly complex, shaped by privatization, autonomy, and online resources. Physician-rating sites and social media let patients compare providers using reviews. Understanding determinants in Saudi Arabia can align care with expectations and improve outcomes. This study examined key factors shaping physician selection.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted using a validated 36-item questionnaire distributed online. Adults aged ≥18 years who had searched for a physician or undergone surgery were eligible. Responses on physician selection factors were rated using a Likert scale. Data were analyzed using SPSS with non-parametric tests to identify key determinants of physician choice.</div></div><div><h3>Results</h3><div>The study included participants aged 18–71 years (mean age 29.35), predominantly female (58.9 %) and of Saudi nationality (89.7 %). The most critical factors were the physician's experience and medical knowledge (83.3 %) and recommendations from other physicians and patients (79.1 %). Only 15 % considered a physician's social media presence essential. While 56 % sought physicians through relatives or friends, 22.4 % used the internet, primarily Google (51.6 %) and Twitter (31.2 %). Participants valued surgical outcomes (82.6 %) and academic qualifications (73.0 %) the most. Discomfort with sharing personal medical information on social media was highest among those undergoing elective surgery (<em>p</em> = 0.007).</div></div><div><h3>Conclusion</h3><div>Patients in Saudi Arabia prioritize physicians’ experience and qualifications, relying heavily on personal recommendations over social media presence. These findings highlight the importance of professional expertise and trusted networks in healthcare provider selection.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100532"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265508","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":"Safe explantation of spinal cord stimulator paddle electrodes","authors":"Zachary T. Olmsted,&nbsp;Michael J. Dorsi","doi":"10.1016/j.wnsx.2025.100508","DOIUrl":"10.1016/j.wnsx.2025.100508","url":null,"abstract":"<div><h3>Objectives</h3><div>Spinal cord stimulation (SCS) technology has become increasingly utilized and understood as a treatment for chronic pain. Epidural paddle electrodes have the advantage of lower rates of migration and infection. While percutaneous leads can be explanted without open surgery, paddle electrode explantation has been considered a high risk procedure. We describe our operative technique and the safety of SCS paddle electrode removal.</div></div><div><h3>Methods</h3><div>Twenty-four consecutive patients underwent SCS paddle stimulator explantation at a single institution between 2017 and 2024. The study was designed to evaluate the safety of SCS paddle electrode removal. Explant patients were identified by CPT code. Cervical explantation patients were excluded from this analysis. We reviewed demographic data, operative technique and postoperative outcomes. We present an operative technique for the safe explantation of paddle electrodes and report on outcomes within 60 days of reoperation.</div></div><div><h3>Results</h3><div>Paddle electrodes were explanted in 24 patients with mean age 59.6 ± 17.4 y (range 25–85). The interval between implant and removal ranged 4–192 mo. Reasons for explantation included ineffective pain relief (<em>n</em> = 16), pain resolution (<em>n</em> = 3), generator pocket pain (<em>n</em> = 4), paddle malpositioning (<em>n</em> = 1), progressive neurologic symptoms related to SCS (<em>n</em> = 3), and need for MRI (<em>n</em> = 7). We emphasize exposing the base of the paddle for ease of removal at the level of insertion.</div></div><div><h3>Conclusions</h3><div>For ineffective pain control or morbidity related to SCS, surgically placed paddle electrodes can be safely and consistently explanted, even after epidural scarring has occurred. Careful exposure of the paddle base is critical. This approach stands in contrast to battery removal only, which is not compatible with future MRI studies.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100508"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892131","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}