World Neurosurgery: X最新文献

{"title":"Management of neurovascular compromise of the vestibulocochlear nerve: A systematic review and illustrative case series","authors":"Vera Ong ,&nbsp;Paul M. Harary ,&nbsp;Amit R. Persad,&nbsp;Yusuke S. Hori,&nbsp;Sara C. Emrich,&nbsp;Louisa Ustrzynski,&nbsp;Armine Tayag,&nbsp;David J. Park,&nbsp;Steven D. Chang","doi":"10.1016/j.wnsx.2025.100557","DOIUrl":"10.1016/j.wnsx.2025.100557","url":null,"abstract":"<div><h3>Objective</h3><div>To review the outcomes of surgery for asymmetric sensorineural hearing loss (ASHL) from neurovascular compromise of the vestibulocochlear nerve.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using the Web of Science, Cochrane, PubMed, and PsychINFO databases. We additionally performed a retrospective review of our institution's database for cases with ASHL resulting from vascular loop-induced vestibulocochlear nerve compression.</div></div><div><h3>Results</h3><div>Fifteen articles were included in our literature review, representing a total of 24 patients. Of these 24 patients, 8 patients were managed conservatively, and 16 patients were managed surgically. Among the patients who underwent conservative management, 4 patients (50 %) had no reported vestibulocochlear post-treatment outcomes. One patient mentioned subjectively improved hearing, whereas the remaining patients either had no change or worsening of hearing loss. One patient reported tinnitus improvement, while another had persistent tinnitus and vertigo. Among the 16 patients who underwent surgery, 7 patients (44 %) showed improved hearing postoperatively, while 1 patient's hearing continued to deteriorate. Improvement of vertigo/disequilibrium and tinnitus was mentioned in 11 and 9 patients, respectively. Separately, our institution presented 2 patients: one treated surgically with mild hearing improvement and another managed conservatively with ongoing evaluation.</div></div><div><h3>Conclusion</h3><div>Indications for treatment of ASHL with associated vascular loop causing vestibulocochlear nerve compression remain unclear. Overlapping vestibulocochlear symptoms of hearing loss and pulsatile tinnitus within a patient case seem of higher surgical priority versus a patient case with worsening hearing.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"29 ","pages":"Article 100557"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617558","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":"Preoperative MRI-based vertebral bone quality (VBQ) scores assessment in patients with severe scoliosis","authors":"Deng Zhao ,&nbsp;Zhong Zhang ,&nbsp;Linbo Jiang ,&nbsp;Lin Li ,&nbsp;Lei Chu ,&nbsp;Zhengkai Zhao","doi":"10.1016/j.wnsx.2025.100565","DOIUrl":"10.1016/j.wnsx.2025.100565","url":null,"abstract":"<div><h3>Object</h3><div>To evaluate the correlation between vertebral bone quality (VBQ) scores and quantitative computer tomography (QCT) based bone mineral density BMD in patients with severe scoliosis, and the correlation between spinal BMD and severity of deformity.</div></div><div><h3>Method</h3><div>We selected patients with severe scoliosis from January 2022 to December 2023 in our hospital. Spinal parameters including main Cobb angle, kyphosis, apical vertebrae evaluated. The BMD was evaluated by QCT technique and VBQ scores was also evaluated. The correlation between the VBQ score and QCT was analyzed. A multivariate logistic regression model was used to analyse factors independently related to osteoporosis.</div></div><div><h3>Results</h3><div>68 patients were evaluated in this study. The overall mean age was 21.7 ± 7.9 years. The mean Cobb angle was 135 ± 20°, and the mean angle of kyphosis was 125 ± 41°. There was a total of 16 (23.5 %) patients with osteoporosis according to QCT. The statistically differences in QCT and VBQ-score were found between Non-osteoporosis group and osteoporosis group. Although the mean age, Cobb angle degree, and kyphosis degree in osteoporosis group were greater than in Non-osteoporosis group, but there were no statistically differences. The VBQ was significantly related with QCT. The model revealed that the VBQ-score could independently associated with osteoporosis in patients with severe scoliosis.</div></div><div><h3>Conclusion</h3><div>The overall prevalence of osteoporosis in severe scoliosis was 23.5 %. The VBQ-scores had a moderate to strong negative linear correlation with QCT-based BMD. The VBQ scores had a moderate diagnostic ability to verify patients with or without osteoporotic BMD in severe scoliosis.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"29 ","pages":"Article 100565"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924913","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":"Demographic, clinical, and social data predictive of 1-month mortality post-aneurysmal subarachnoid hemorrhage","authors":"Ansley Grimes Stanfill ,&nbsp;Xueyuan Cao ,&nbsp;Patrick Devlin ,&nbsp;Lucas Elijovich ,&nbsp;Adam Arthur ,&nbsp;Kayla M. Wynja ,&nbsp;Drew Prescott ,&nbsp;Brandon Baughman","doi":"10.1016/j.wnsx.2025.100563","DOIUrl":"10.1016/j.wnsx.2025.100563","url":null,"abstract":"<div><h3>Introduction</h3><div>Attempts to develop a multidimensional predictive model for outcomes after aneurysmal subarachnoid hemorrhage have largely failed. Other demographic, clinical, and social information may enhance the predictive value of clinical scales for the prognostication of outcomes. This study investigates other factors that may also be influential for 1-month mortality.</div></div><div><h3>Materials and methods</h3><div>An existing quality control database was interrogated for ICD-9/10 codes of 430/I60. Missing data were handled by multiple imputations with predictive mean method. The probability of mortality at 1-month was regressed on each predictor variables with results pooled to estimate regression coefficients; a multivariable model was constructed by a backward model selection procedure.</div></div><div><h3>Results</h3><div>The 1286 subjects averaged 53 years old, were 51.5 % Caucasian and 71.2 % female. Mortality rate was 13.7 % at 1 month. Of the 24 factors interrogated, 10 were significantly (<em>p</em> &lt; 0.05) associated with death (age; race; marital status; employment status; cardiac history; diabetes; treatment method; Glasgow Coma Scale score [GCS]; modified Fisher Group score [mFGS]; Hunt Hess Grade). The final model had four predictors: age (OR 1.08; <em>p</em> &lt; 0.0001), employment status (OR 0.29; <em>p</em> = 0.0051), treatment method (OR 13.11; <em>p</em> = 0.0007), and Hunt Hess Grade (OR 2.45; <em>p</em> &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>Our model, constructed from a fairly large and diverse sample, demonstrates that the inclusion of additional demographic, clinical, and social variables improves predictive power beyond that offered by traditional clinical grading scales. Future work should examine the utility of this or a similar model for prediction of morbidity and long-term functional outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"29 ","pages":"Article 100563"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924912","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":"Real-time augmented reality trajectory lines technique for deep-seated glioblastoma: Technical note","authors":"Yoshiki Fujikawa,&nbsp;Shinji Kawabata,&nbsp;Hironori Yamada,&nbsp;Yuichiro Tsuji,&nbsp;Masahiko Wanibuchi","doi":"10.1016/j.wnsx.2025.100562","DOIUrl":"10.1016/j.wnsx.2025.100562","url":null,"abstract":"<div><h3>Objective</h3><div>To describe a practical and reproducible technique for real-time augmented reality (AR)–guided microsurgery, achieved through direct linkage between the surgical microscope and neuronavigation system, applied to the resection of a deep-seated glioblastoma.</div></div><div><h3>Methods</h3><div>A real-time AR visualization system was implemented by connecting a surgical microscope (ZEISS KINEVO 900) with a neuronavigation platform (StealthStation S8, Medtronic). The system dynamically projected tumor boundaries and depth-sensitive trajectory lines into the operative view, providing continuous spatial guidance without the need for additional instruments. The technique was applied during subpial dissection and resection of a deeply located frontal glioblastoma extending toward the corpus callosum.</div></div><div><h3>Results</h3><div>Dynamic AR trajectory lines enabled precise delineation of resection margins and depth while maintaining a seamless surgical workflow. Near-total tumor removal was achieved under direct microscopic AR visualization without introducing additional mechanical intrusion such as catheter placement or stereotactic probes. Postoperative MRI confirmed safe and effective resection, and neurological function was preserved.</div></div><div><h3>Conclusion</h3><div>This technical note illustrates the feasibility and potential advantages of real-time microscope-linked AR guidance for deep-seated glioblastoma resection. The method is readily applicable in standard neurosurgical settings, requiring no specialized equipment or additional cost. Institutional review board approval was obtained, and written informed consent for the procedure and publication was secured.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"29 ","pages":"Article 100562"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924914","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":"Acinetobacter baumannii ventriculoperitoneal shunt infection in the pediatric population: Clinical assessment and microbiological profile","authors":"Amer A. Jaradat ,&nbsp;Mohammed M. Barbarawi ,&nbsp;Mohammed Jamous ,&nbsp;Sultan M. Jarrar ,&nbsp;Suleiman S. Daoud ,&nbsp;Amjed Abdelal ,&nbsp;Said Haddad ,&nbsp;Reem Alazzam ,&nbsp;Marah Bashyreh ,&nbsp;Owais Ghammaz","doi":"10.1016/j.wnsx.2025.100552","DOIUrl":"10.1016/j.wnsx.2025.100552","url":null,"abstract":"<div><h3>Background</h3><div>Ventriculoperitoneal (VP) shunt infections, notably when caused by <em>Acinetobacter baumannii</em>, present significant management challenges in pediatric neurosurgery due to antibiotic resistance. This study assesses clinical profiles, microbiological characteristics, treatment strategies, and outcomes of these infections.</div></div><div><h3>Methods</h3><div>A retrospective review at King Abdullah University Hospital, North Jordan, analyzed 27 pediatric cases of <em>Acinetobacter baumannii</em> VP shunt infections from 2013 to 2023. Data on demographics, clinical presentation, treatment strategies, and outcomes, including cerebrospinal fluid (CSF) clearance time and time to shunt re-insertion, morbidity, and mortality were evaluated.</div></div><div><h3>Results</h3><div>Colistin showed efficacy against multidrug-resistant strains, despite overall high resistance to conventional antibiotics. Infections predominantly occurred early post-surgery and an 11.1 % mortality rate was observed.</div></div><div><h3>Conclusion</h3><div>VP shunt infections caused by <em>Acinetobacter baumannii</em> significantly impact pediatric patients, emphasizing the need for early detection and the development of targeted treatment approaches. Colistin may offer a viable option against resistant strains, but prolonged hospitalization and mortality rates call for improved preventive measures.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"29 ","pages":"Article 100552"},"PeriodicalIF":2.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145683121","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":"Total iron and Fe2+ concentration in cerebrospinal fluid are strongly correlated with the incidence of hydrocephalus in intracerebral hemorrhage patients with intraventricular extension","authors":"Petra Octavian Perdana Wahjoepramono ,&nbsp;Aloysius Bagus Sasongko ,&nbsp;Danny Halim ,&nbsp;Kurnia Wahyudi ,&nbsp;Achmad Adam ,&nbsp;Yeo Tseng Tsai ,&nbsp;Eka Julianta Wahjoepramono ,&nbsp;Julius July ,&nbsp;Tri Hanggono Achmad","doi":"10.1016/j.wnsx.2025.100514","DOIUrl":"10.1016/j.wnsx.2025.100514","url":null,"abstract":"<div><h3>Background</h3><div>Hydrocephalus is a known complication of spontaneous intracerebral hemorrhage (ICH) extending into the cerebral ventricles (Intraventricular Hemorrhage, IVH) and is associated with poorer patient outcomes. Accurately predicting the risk of shunt-dependent hydrocephalus could help anticipate the need for permanent CSF diversion in these patients and improve outcomes. Based on the suspected molecular pathogenesis of hydrocephalus, certain biomarkers may be reliable predictors of shunt-dependent hydrocephalus in ICH + IVH patients.</div></div><div><h3>Aim</h3><div>This study aimed to test the reliability of Fe²⁺, Fe³⁺, total iron concentration, and high mobility group box 1 (HMGB1) protein levels in the cerebrospinal fluid to predict the risk of shunt-dependent hydrocephalus in patients with ICH + IVH.</div></div><div><h3>Methods</h3><div>This prospective cohort study included all adult ICH + IVH patients with hydrocephalus admitted to Siloam Hospitals Lippo Village between March 2021 and December 2023. Patient demographics, radiological characteristics, and CSF samples were analyzed to evaluate the clinical, radiological, and molecular parameters associated with the risk of shunt-dependent hydrocephalus.</div></div><div><h3>Results</h3><div>Thirty-six patients were included. Seventeen patients (47.2 %) developed shunt-dependent hydrocephalus. Analysis showed that increased total Fe (<em>p</em> = 0.048) and Fe²⁺ (<em>p</em> = 0.045) concentrations were significantly associated with the incidence of hydrocephalus. The AUCs of total iron (0.716), Fe²⁺ (0.758), Fe³⁺ (0.651), and HMGB1 (0.722) were higher than that of the mGraeb score (0.528) in predicting shunt-dependent hydrocephalus.</div></div><div><h3>Conclusion</h3><div>CSF total iron and Fe²⁺ levels are reliable predictors of hydrocephalus in patients with ICH + IVH. These biomarkers are more sensitive and specific in predicting shunt-dependent hydrocephalus compared to the mGraeb score.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100514"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004164","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":"Intervertebral disc degeneration and stroke: A bidirectional two-sample Mendelian randomization study","authors":"Yifan Wang ,&nbsp;Rong Zhou ,&nbsp;Shaoting Nan ,&nbsp;Yanlong Duan ,&nbsp;Lei Cao ,&nbsp;Shenglong Guo","doi":"10.1016/j.wnsx.2025.100535","DOIUrl":"10.1016/j.wnsx.2025.100535","url":null,"abstract":"<div><h3>Background</h3><div>Although previous studies suggest a possible association between intervertebral disc degeneration (IVDD) and stroke, the causal relationship between them remains unclear.</div></div><div><h3>Methods</h3><div>Genetic instrumental variables for IVDD were obtained from the FinnGen database; data for stroke, ischemic stroke (IS), and Intracerebral hemorrhage (ICH) were sourced from the MEGASTROKE consortium. All genome-wide association study (GWAS) datasets were accessed through the IEU online database. The inverse-variance weighted (IVW) method was used as the primary analysis approach, incorporating a rigorous framework, including bidirectional Mendelian randomization and various sensitivity analyses to avoid potential confounding biases.</div></div><div><h3>Results</h3><div>The MR analysis revealed a positive causal relationship between IVDD and stroke(OR = 1.168, 95 %CI: [1.033, 1.320], <em>p</em> = 0.01). Additionally, IVDD was found to increase the risk of IS (IVW: OR = 1.171, 95 %CI: [1.025, 1.337], <em>p</em> = 0.02). Reverse analysis showed no causal relationship between stroke and IVDD risk. Heterogeneity, pleiotropy, and statistical power analyses confirmed the robustness of these findings.</div></div><div><h3>Conclusion</h3><div>There is a causal relationship between IVDD and stroke. These findings suggest that IVDD may be a risk factor for stroke. Therefore, interventions and treatments targeting IVDD could potentially reduce the incidence and mortality rates of stroke.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100535"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145319594","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":"Perception of neurosurgery among surgical patients with essential tremor: A qualitative mixed methods study","authors":"Susanna D. Howard ,&nbsp;Ellie Gabriel ,&nbsp;Shikha Singh ,&nbsp;Iahn Cajigas ,&nbsp;Whitley Aamodt ,&nbsp;John Farrar ,&nbsp;Matthew D. Kearney","doi":"10.1016/j.wnsx.2025.100504","DOIUrl":"10.1016/j.wnsx.2025.100504","url":null,"abstract":"<div><h3>Background</h3><div>There is a dearth of evidence on knowledge and perceptions of procedures among patients with essential tremor (ET). The objective of this study was to utilize a mixed methods design incorporating in-depth individual interviews to investigate the perception of procedures among patients with ET who underwent surgical intervention.</div></div><div><h3>Methods</h3><div>Semi-structured, in-depth individual interviews paired with survey questionnaires were conducted among participants with ET who had a prior surgical procedure for the disorder. Thematic analysis of qualitative data was conducted using an approach based on grounded theory methodology.</div></div><div><h3>Results</h3><div>Of the 20 patients interviewed, nine patients (45 %) had undergone magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy, nine patients (45 %) had undergone deep brain stimulation (DBS) implantation, and two patients (10 %) had undergone both DBS implantation and MRgFUS thalamotomy. In ranking factors from most to least important in deciding which type of surgery to undergo, patients most frequently selected safety as the most important factor (9/20, 45 %). Hair shave required was most frequently selected as the least important factor (14/20, 70 %). Seven patients (35 %) reported having zero or minimal knowledge of the risks and benefits of either MRgFUS thalamotomy or DBS before their surgery. Patients discussed their surgical outcomes including adverse effects of surgery.</div></div><div><h3>Conclusions</h3><div>In deciding which type of surgery to undergo for tremor, participants discussed the role of safety, perceived invasiveness, and follow-up care required. Participants reflected on the life-changing benefits of tremor control but also discussed detrimental adverse effects such as dysarthria and gait instability following surgery.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100504"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831390","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 range of motion and muscle strength after idiopathic scoliosis surgery using fusion or anterior dynamic fixation","authors":"Vladimir Pereverzev,&nbsp;Arkadii Kazmin,&nbsp;Sofia Eremushkina,&nbsp;Sergey Kolesov","doi":"10.1016/j.wnsx.2025.100507","DOIUrl":"10.1016/j.wnsx.2025.100507","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the changes of range of motion and spinal muscle strength after surgical correction of adolescent idiopathic scoliosis with the use of an intelligent biofeedback system.</div></div><div><h3>Methods</h3><div>Retrospective study of 48 adolescent idiopathic scoliosis patients: posterior fusion, PFS (Group 1, n = 22), anterior scoliosis correction (dynamic fixation) (Group 2, n = 14), and hybrid fixation (Group 3, n = 12). Range of motion and isometric strength were assessed using the Tergumed Pegasus 3D system. Statistical analysis used Mann–Whitney U and Kruskal–Wallis tests (p &lt; 0.05).</div></div><div><h3>Results</h3><div>Group 1 (PFS) had the worst outcomes: limited rotation (26–31°), 47.5 % reduced extensor strength, and only 52.5 % of normal rotation. Group 2 (ASC) showed improved rotation (39–47°) and doubled extensor strength (143.5 Nm). Group 3 (hybrid fixation) had the best results: near-normal rotation (47–48°), full extensor strength recovery (106 %), and 95 % of retention of available mobility. Group 2 and Group 3 outperformed Group 1 in rotation degrees, while Group 3 showed better flexion, extension, and lateral bending. Back extensor strength in Group 1 was half that of Group 2 and Group 3. Group 3 did better than Group 1 in both range of motion and strength, while there were no significant differences between Group 2 and Group 3.</div></div><div><h3>Conclusion</h3><div>When using anterior (dynamic) scoliosis correction, the amount of spinal movement is greater, compared to posterior fusion. Muscle strength is also significantly higher during extension. Therefore, ASC is an effective method of scoliosis treatment and further research with more cases is needed to have better understanding of its benefits.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100507"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144879529","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":"Grading the damage: Prognostic significance of diffuse axonal injury severity and hemorrhagic lesions in traumatic brain injury outcomes","authors":"Nanci Estefanía Bayas-Almeida ,&nbsp;Fabricio González-Andrade","doi":"10.1016/j.wnsx.2025.100539","DOIUrl":"10.1016/j.wnsx.2025.100539","url":null,"abstract":"<div><h3>Background</h3><div>Diffuse axonal injury (DAI) is a key determinant of prognosis in traumatic brain injury (TBI), yet the interaction between DAI severity and associated hemorrhagic lesions is not well defined, especially in low- and middle-income countries (LMICs).</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of 283 adults with moderate-to-severe TBI admitted to a tertiary hospital in Ecuador (2019–2023). DAI severity was graded anatomically using CT or MRI, and patients were stratified by the presence of hemorrhagic lesions. Demographic, clinical, metabolic, and radiological variables were collected. Outcomes were evaluated at 6 months with the Glasgow Outcome Scale–Extended (GOS-E). Logistic and ordinal regression models identified predictors of mortality and disability.</div></div><div><h3>Results</h3><div>Of 283 patients, 141 had isolated DAI and 142 had DAI with hemorrhage. Baseline demographics were similar. Patients with hemorrhagic lesions had lower median Glasgow Coma Scale scores (6 vs 9, <em>p</em> &lt; 0.001), more frequent hyperglycemia (15.5 % vs 7.1 %, <em>p</em> = 0.045), and greater surgical needs (77.5 % vs 16.3 %, <em>p</em> &lt; 0.001). Complications, including pneumonia and central nervous system infections, were more frequent in the hemorrhagic group (63.9 % vs 45.7 %, <em>p</em> &lt; 0.001). At 6 months, functional outcomes were significantly worse with hemorrhage (median GOS-E 7 vs 8, <em>p</em> &lt; 0.001). Multivariable regression identified Grade III DAI as the strongest predictor of mortality (OR 20.02, 95 % CI 7.99–50.15) and disability (OR 71.59, 95 % CI 23.11–221.77). Hemorrhagic lesions predicted poor functional recovery (OR 2.08, 95 % CI 1.24–3.48) but not mortality.</div></div><div><h3>Conclusions</h3><div>DAI grading is the most powerful prognostic factor in severe TBI, while hemorrhagic lesions primarily worsen disability. In LMICs, CT-based assessment remains essential for prognostic stratification and guiding rehabilitation strategies.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100539"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145264772","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}