World Neurosurgery: X最新文献

{"title":"Pedunculopontine-region deep brain stimulation for gait dysfunction in Parkinson's disease: A network-based review of anatomical and circuit determinants of clinical response","authors":"Nana Tchantchaleishvili,&nbsp;Grigol Tchatchia,&nbsp;Tsotne Chkhikvishvili,&nbsp;Zhangjie Su,&nbsp;Andrii Netliukh,&nbsp;Mario Ganau","doi":"10.1016/j.wnsx.2026.100614","DOIUrl":"10.1016/j.wnsx.2026.100614","url":null,"abstract":"<div><h3>Background</h3><div>Axial gait impairment, freezing of gait, postural instability, and falls remain major therapeutic challenges in advanced Parkinson's disease. Although subthalamic and pallidal deep brain stimulation improve appendicular motor features, gait and balance responses are less predictable. Pedunculopontine-region deep brain stimulation has been investigated for medication-refractory gait dysfunction, but outcomes vary. This review aims to identify anatomical, circuit-level, stimulation-related, and patient-specific determinants that may explain heterogeneous responses.</div></div><div><h3>Methods</h3><div>We conducted a structured narrative review of studies addressing pedunculopontine-region deep brain stimulation, freezing of gait, postural instability, mesencephalic locomotor circuitry, surgical targeting, stimulation parameters, and pathway recruitment in Parkinson's disease. Evidence was synthesized thematically, with clinical efficacy considered separately from anatomical localization, biological plausibility, and pathway-recruitment evidence.</div></div><div><h3>Results</h3><div>Low-frequency pedunculopontine-region stimulation may improve freezing of gait, falls, gait initiation, or balance in selected patients. However, this therapeutic signal remains inconsistent across small cohorts, controlled studies, single-case reports, combined-target studies, and clinical syntheses. Variability appears related to patient phenotype, target terminology, active-contact location, laterality, stimulation frequency and amplitude, medication state, and adjacent pathway recruitment. Anatomical and imaging studies indicate that the pedunculopontine region is not a sharply bounded clinical target, while computational modeling shows that small differences in electrode position and stimulation settings can alter recruited pathways.</div></div><div><h3>Conclusions</h3><div>Pedunculopontine-region deep brain stimulation remains promising but unresolved for gait dysfunction in Parkinson's disease. Current evidence supports a network-based interpretation rather than a uniform single-nucleus efficacy model. Future studies should prioritize precise target terminology, patient-specific imaging for target and active-contact localization, contact-level reporting, standardized outcome measures, and computational pathway modeling.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"31 ","pages":"Article 100614"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retraction notice to “Microsurgical partial trapping for the treatment of unclippable vertebral artery aneurysms: Experience from 27 patients and review of literature” [World Neurosurg: X, 21 (2023); 100256]","authors":"Kittipos Techasrisaksakul,&nbsp;Kitiporn Sriamornrattanakul,&nbsp;Nasaeng Akharathammachote,&nbsp;Areeporn Chonhenchob,&nbsp;Atithep Mongkolratnan,&nbsp;Chanon Ariyaprakai","doi":"10.1016/j.wnsx.2026.100605","DOIUrl":"10.1016/j.wnsx.2026.100605","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"31 ","pages":"Article 100605"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal machine learning for predicting spine surgery recommendation using radiology reports, clinical notes, and structured clinical data","authors":"Sean Lau,&nbsp;Alex Flores,&nbsp;Elizabeth Ledbetter,&nbsp;Vijay Nitturi,&nbsp;Thomas Hamre,&nbsp;Tristan Morgan,&nbsp;Thomas O'Donnell,&nbsp;Shragvi Balaji,&nbsp;Nedim Ozden,&nbsp;Shankar Gopinath","doi":"10.1016/j.wnsx.2026.100616","DOIUrl":"10.1016/j.wnsx.2026.100616","url":null,"abstract":"<div><h3>Objective</h3><div>With the need for efficient triaging methods in spine clinic increasing, machine learning and natural language processing (NLP) transformer models have demonstrated effectiveness in predicting surgical recommendations, offering a potential approach for patient stratification. We evaluated an integrated fusion model, trained on radiology reports, clinical notes, and clinical variables, to predict spine surgery recommendations in an all-comer population.</div></div><div><h3>Methods</h3><div>A single-institution cohort of spine clinic patients with over 50 ICD-coded spine pathologies was analyzed. From initial clinic visits, we collected radiology reports, clinic notes, structured clinical variables, and surgery recommendation status within one year. Separate unimodal models were developed for each data modality: radiology impressions, clinic notes, and structured clinical variables. Outputs from component models were subsequently integrated using logistic regression to create late-fusion models. We developed seven late-fusion models incorporating different NLP transformer backbones (e.g., BERT and GatorTRON). Performance was assessed using 5-fold cross-validation with area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity with 95% confidence intervals.</div></div><div><h3>Results</h3><div>Within one year of initial clinic visit, 35% of 972 patients were offered spine surgery. Late-fusion models exhibited varying performances in predicting spine surgical recommendation (AUROC range: 0.69 – 0.81). The GatorTRON late-fusion model was the best performer (AUROC 0.81; 95% CI 0.78 – 0.83). Furthermore, among the three component modalities, the radiology-only model provided the largest contribution to late-fusion model performance.</div></div><div><h3>Conclusions</h3><div>Our investigation revealed that an integrated machine learning model can robustly predict spine surgical recommendation from multimodal data available at initial spine clinic visits.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"31 ","pages":"Article 100616"},"PeriodicalIF":2.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Robotic Stereotactic Assistance (ROSA) with intraoperative mobile CT for intracerebral hemorrhage aspiration: technical note and case series","authors":"Charlton Chen-Ting Cheng ,&nbsp;Tzu-Hao Yen ,&nbsp;Chih-Hsiu Tu ,&nbsp;Chien-Tung Yang ,&nbsp;Jeng-Hung Guo ,&nbsp;Yu-Kai Cheng ,&nbsp;Hung-Lin Lin ,&nbsp;Chun-Chung Chen","doi":"10.1016/j.wnsx.2026.100591","DOIUrl":"10.1016/j.wnsx.2026.100591","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to present a novel technique combining robotic stereotactic assistance (ROSA) with intraoperative mobile CT (AIRO CT) for the aspiration of spontaneous intracerebral hemorrhage (ICH).</div></div><div><h3>Methods</h3><div>We present a case series of cases combining ROSA and AIRO CT for hematoma aspiration, with detailed procedural descriptions in basal ganglia and lobar ICH patients treated between 2024 and 2025.</div></div><div><h3>Results</h3><div>Twenty patients achieved satisfactory hematoma clearance confirmed by intraoperative AIRO CT. Two patients attained favorable neurological outcomes (modified Rankin Scale≤ 2), and four demonstrated intermediate recovery (mRS = 3), indicating partial functional improvement. One patient expired within 30 days due to non-neurological causes.</div></div><div><h3>Conclusions</h3><div>Our integrated technique combining ROSA and AIRO CT provides a feasible and practical approach for minimally invasive ICH evacuation. This method enhances hematoma clearance, improves intraoperative confidence, and increases overall surgical safety.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"30 ","pages":"Article 100591"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147656698","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":"The maternal-fetal trade-off in pregnancy-associated meningioma management: A systematic review and meta-analysis","authors":"Agung Budi Sutiono,&nbsp;Yulius Hermanto","doi":"10.1016/j.wnsx.2026.100571","DOIUrl":"10.1016/j.wnsx.2026.100571","url":null,"abstract":"<div><div>The management of pregnancy-associated meningioma (PAM) necessitates a critical balance between preserving maternal neurological function and ensuring fetal safety. This study aims to systematically evaluate the maternal and fetal outcomes associated with different management strategies for PAM by synthesizing the available evidence. This systematic review and meta-analysis quantitatively synthesize evidence from 5 studies (144 patients) from January 1, 2010, to December 31, 2024, to evaluate trade-offs between maternal and fetal outcomes across three management pathways: antepartum surgery, planned early postpartum surgery (≤7 days post-delivery), and deferred surgery/conservative management. Maternal neurological recovery was similarly high across all groups (89 %, 90 %, and 86 %, respectively). However, a clear gradient in fetal risk was observed: preterm delivery (&lt;37 weeks) occurred in 38 % (95 % CI: 30–46 %) of the antepartum surgery group, 15 % (95 % CI: 9–23 %) of the planned early postpartum group, and 10 % (95 % CI: 5–17 %) of the deferred management group. The risk ratio for preterm delivery was 3.2 (95 % CI: 2.0–5.1) for antepartum versus combined postpartum pathways. Vaginal delivery was most common in the deferred group (66 %) and planned early postpartum group (60 %). In conclusion, these findings support a risk-stratified approach: antepartum surgery remains effective for neurologically declining mothers but carries the highest fetal risk, while planned early postpartum intervention offers a middle-ground, and deferred management is safest for the fetus in stable patients. Clinical decision-making should be individualized and guided primarily by maternal neurological status within a multidisciplinary framework.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"30 ","pages":"Article 100571"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081789","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":"Analysis of risk factors for planned tracheal extubation failure in patients after posterior fossa surgery","authors":"Haotian Wu,&nbsp;Xianglong Cai,&nbsp;Yi Ma,&nbsp;Yan Xu","doi":"10.1016/j.wnsx.2026.100575","DOIUrl":"10.1016/j.wnsx.2026.100575","url":null,"abstract":"<div><h3>Objective</h3><div>To identify risk factors influencing planned tracheal extubation failure in patients after posterior fossa surgery.</div></div><div><h3>Methods</h3><div>A total of 74 patients admitted to the neurosurgical intensive care unit of a tertiary hospital between January 2022 and January 2024 were enrolled in this study using a convenience sampling method. Clinical data and parameters related to tracheal extubation were collected and analyzed. Risk factors for extubation failure were identified using univariate analysis and binary logistic regression analysis.</div></div><div><h3>Results</h3><div>Among the 74 patients, 18 experienced tracheal extubation failure. Univariate analysis revealed significant differences in pre-extubation Glasgow Coma Scale (GCS) score, pneumonia, cough strength scores, suction frequency, hypercapnia, and dysphagia after extubation (<em>P</em> &lt; 0.05). Binary logistic regression identified weak cough strength, hypercapnia, and high suction frequency as risk factors for extubation failure in these patients.</div></div><div><h3>Conclusion</h3><div>Cough strength, Hypercapnia, and suction frequency are key determinants of tracheal extubation outcomes in patients after posterior fossa surgery.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"30 ","pages":"Article 100575"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191382","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":"Risk factors for optic neuropathy after clipping for paraclinoid aneurysms: A retrospective study","authors":"Junya Iwama ,&nbsp;Hiroki Sato ,&nbsp;Seiji Kuribara ,&nbsp;Makoto Mizushima ,&nbsp;Takumi Hirabayashi ,&nbsp;Ryosuke Tsuchiya ,&nbsp;Takafumi Shindo ,&nbsp;Keisuke Ohnaka ,&nbsp;Takanori Hayakawa ,&nbsp;Katsumi Takizawa","doi":"10.1016/j.wnsx.2026.100568","DOIUrl":"10.1016/j.wnsx.2026.100568","url":null,"abstract":"<div><h3>Background</h3><div>Anterior clinoidectomy (AC) is an important technique for the management of aneurysms in the paraclinoid region. Conventional drill-based AC technique (Drill AC) can cause optic neuropathy. Therefore, starting in July 2017, we transitioned to a drill-less method, using a rongeur-based AC technique (Rongeur AC). Herein, we aimed to compare the outcomes of these two techniques in our institution.</div></div><div><h3>Methods</h3><div>This retrospective study included 81 patients with paraclinoid aneurysms who underwent craniotomy with AC between January 2012 and September 2023. The patients were divided into two groups for the primary analysis: Drill AC (<em>n</em> = 41) and Rongeur AC (<em>n</em> = 40). For a secondary analysis to identify risk factors, the patients were regrouped based on the presence (<em>n</em> = 16) or absence (<em>n</em> = 65) of postoperative optic neuropathy. Patient characteristics, surgical techniques, and outcomes were compared.</div></div><div><h3>Results</h3><div>The incidence rate of postoperative optic neuropathy was significantly lower in the Rongeur AC group than in the Drill AC group (10.0 % vs. 29.3 %, <em>P</em> = 0.049). In the analysis of the risk factors for optic neuropathy, superior and medial incisions of the distal dural ring were significantly more common in patients with optic neuropathy than in those without optic neuropathy (<em>P</em> = 0.018 and <em>P</em> = 0.009, respectively).</div></div><div><h3>Conclusion</h3><div>Rongeur AC may help reduce the risk of optic neuropathy, and the distal dural ring incision trajectory appears to modulate this risk. Confirmation in multicenter cohorts is a priority.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"30 ","pages":"Article 100568"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191379","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":"Vascular loops and pulsatile tinnitus: Culprit or innocent bystander? – An illustrative case and systematic literature review","authors":"Hector R. Martinez ,&nbsp;Sofia L. Rivera-Torres ,&nbsp;Carlos Cuilty-Siller ,&nbsp;Cristo G. Sanchez ,&nbsp;Alberto Tueme ,&nbsp;Paola Velediaz ,&nbsp;Nerea Martin de Campo ,&nbsp;Guillermo Kenji Pons ,&nbsp;Azalea G. Baez ,&nbsp;Oscar Gutierrez-Trevino ,&nbsp;Beatriz Perez-Martinez ,&nbsp;Jose A. Moran Guerrero ,&nbsp;Jose A. Figueroa-Sanchez","doi":"10.1016/j.wnsx.2026.100574","DOIUrl":"10.1016/j.wnsx.2026.100574","url":null,"abstract":"<div><div>Vascular loops are a common finding on imaging and their clinical significance depends on whether they cause compression of nearby structures. The association of vascular loops as a direct cause of otological symptoms such as pulsatile tinnitus (PT) is currently under debate. PT can be an incapacitating condition, so efforts to correctly identify and classify its cause must be made to provide an appropriate intervention and symptom relief. We present 5 illustrative cases of patients who came to our institution with complaints of PT, where imaging studies revealed a vascular loop. Furthermore, we performed a literature search using the MEDLINE, Scopus and Web of Science databases to look for cases of PT associated with vascular loops. Our review yielded a total of 52 studies, with only 4 articles (31 patients), specifying a clinical presentation of both PT and vascular loop in the same patient. Although there appears to be a connection between the presence of vascular loops and the manifestation of pulsatile tinnitus, current studies have not proved direct causality.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"30 ","pages":"Article 100574"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191378","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":"Gut–brain axis in Parkinson's and Alzheimer's disease: Emerging clinical and therapeutic implications","authors":"Dr Sneha Pawar","doi":"10.1016/j.wnsx.2026.100578","DOIUrl":"10.1016/j.wnsx.2026.100578","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"30 ","pages":"Article 100578"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191488","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":"Revisiting decompressive craniectomy thresholds in traumatic brain injury: Are we operating too early or too late?","authors":"Rita Sangtani","doi":"10.1016/j.wnsx.2026.100576","DOIUrl":"10.1016/j.wnsx.2026.100576","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"30 ","pages":"Article 100576"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191380","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}