World Neurosurgery: X最新文献

{"title":"Neurosurgical sepsis protocols following craniotomy: Clinical outcomes and survival analysis","authors":"Panu Boontoterm ,&nbsp;Siraruj Sakoolnamarka ,&nbsp;Karanarak Urasyanandana ,&nbsp;Pusit Fuengfoo","doi":"10.1016/j.wnsx.2025.100519","DOIUrl":"10.1016/j.wnsx.2025.100519","url":null,"abstract":"<div><h3>Objectives</h3><div>Central nervous system infections after craniotomy are associated with high perioperative mortality and morbidity. Despite the availability of Surviving Sepsis Campaign (SSC) guidelines, few studies have evaluated their clinical impact in neurosurgical patients. This study aimed to assess mortality and key clinical outcomes following SSC protocol implementation.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, 139 patients with neurosurgical sepsis were enrolled and divided into two groups: 67 patients received the SSC protocol (protocol group), and 72 patients received standard care (usual care group). Baseline characteristics, early resuscitation metrics, and clinical outcomes were compared over a 30-day follow-up period.</div></div><div><h3>Results</h3><div>The SSC protocol group demonstrated significantly improved survival, with a longer median survival time (20 vs. 15 days, <em>p</em> &lt; 0.001) and reduced ICU stay, hospital stay, and increased ventilator- and vasopressor-free days (<em>p</em> &lt; 0.001 for all). Early initiation of antibiotics, vasopressors, and source control was achieved more rapidly in the protocol group. Among adjunct therapies, intravenous hydrocortisone significantly reduced vasopressor duration and hospital length of stay (<em>p</em> = 0.001 and <em>p</em> &lt; 0.001, respectively). Thiamine was associated with shorter hospital stays (<em>p</em> = 0.023), while CRRT contributed to reduced vasopressor requirements (<em>p</em> = 0.013).</div></div><div><h3>Conclusions</h3><div>Implementation of SSC protocols in neurosurgical sepsis following craniotomy significantly improved survival and key clinical outcomes. Hydrocortisone and CRRT were associated with reduced vasopressor needs, and thiamine use correlated with decreased hospital stay. Early sepsis management protocols may improve outcomes in this high-risk population.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100519"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043916","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":"Electrodiagnostic signatures of lower-limb nerve dysfunction in children with spina bifida: A retrospective case-control study","authors":"Ting-Jie I ,&nbsp;Yu-Cheng Chou ,&nbsp;Chia-Man Chou ,&nbsp;Jimmy, Chun-Ming Fu","doi":"10.1016/j.wnsx.2025.100547","DOIUrl":"10.1016/j.wnsx.2025.100547","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral‐nerve abnormalities contribute to lower-limb disability in children diagnosed with spina bifida, yet paediatric, norm-referenced electrodiagnostic data are scarce. This study characterized lower-limb nerve-conduction deviations in this population.</div></div><div><h3>Methods</h3><div>We performed a single-centre retrospective case–control review of lower-limb nerve-conduction studies (NCS) performed between January 2019 and January 2024. Sixteen children with clinically or image-confirmed spina bifida met the inclusion criteria. Distal latency, conduction velocity and amplitude of the common peroneal, tibial and sural nerves were all recorded using the American Clinical Neurophysiology Society guidelines. Values were compared with age-matched paediatric norms via Wilcoxon signed-rank testing (<em>α</em> = 0.05).</div></div><div><h3>Results</h3><div>A total of 16 patients were included. Peroneal compound muscle-action-potential (CMAP) amplitudes were significantly reduced bilaterally versus norms (median difference right − 1.9 mV, <em>p</em> = 0.003; left − 1.7 mV, <em>p</em> = 0.001), whereas distal latency and velocity were preserved. Sural nerves exhibited prolonged distal latency on both sides (right −1.0 ms, <em>p</em> = 0.001; left −1.01 ms, <em>p</em> = 0.01) without any amplitude or velocity change. No significant differences were observed in any tibial nerve parameters. All subjects generated recordable motor and sensory responses.</div></div><div><h3>Conclusions</h3><div>Children diagnosed with spina bifida demonstrate a characteristic electrodiagnostic profile—attenuated peroneal CMAP combined with isolated sural latency prolongation—suggesting distal axonal loss and focal demyelination of selected lower-extremity nerves. However, the cross-sectional design and lack of functional assessment limit the prognostic value of the characteristics. Future research focused on the correlation of longitudinal NCS parameters and functional outcomes should be warranted.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100547"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464885","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":"Skull base giant cell tumors uncovered: Clinical challenges and evolving treatment strategies – A case and literature review","authors":"Gervith Reyes Soto ,&nbsp;Carlos Castillo Rangel ,&nbsp;Ismail Bozkurt ,&nbsp;Daniel Alejandro Vega Moreno ,&nbsp;Andreina Rosario Rosario ,&nbsp;Ruben Dario Bleubar Ozoria ,&nbsp;Renat Nurmukhametov ,&nbsp;Manuel De Jesús Encarnación Ramirez","doi":"10.1016/j.wnsx.2025.100527","DOIUrl":"10.1016/j.wnsx.2025.100527","url":null,"abstract":"<div><h3>Background</h3><div>Giant cell tumor (GCT) is a low frequency, benign neoplasm that generally produces lytic lesions. It mainly affects women in the third to fifth decade of life. Its most frequently reported location is in the temporal bone, especially the petrous portion, followed by the sphenoid. There are multiple lines of treatment; however, surgical management remains the standard treatment.</div></div><div><h3>Methods</h3><div>An 18-year-old man presented with diplopia. Through imaging studies and biopsy, he was diagnosed with a GCT of the cranial base. The patient was managed surgically on two occasions and with complementary treatment with denosumab, which achieved complete remission and a total reduction in tumor volume. A systematic review of previously published studies was conducted.</div></div><div><h3>Results</h3><div>We identified a total of 128 records through database searching from PubMed, Medline, and Scopus. The screening process left 23 records for detailed review. Upon further evaluation, nine non-research letters or commentaries were excluded, resulting in 15 full-text articles being included in the final review.</div></div><div><h3>Conclusions</h3><div>GCTs have benign histological characteristics; however, the bony lytic destruction makes their management difficult. The main stray treatment modality continues to be surgery. However, as presented in our case supported with multiple studies adjuvant treatment with denosumab yields good responses.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100527"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095025","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":"Franz Anton Mesmer and the advancements in electromagnetic brain stimulation: from a flawed perspective to the transcranial magnetic stimulation","authors":"Davide Costazza,&nbsp;Andreas Schwarz,&nbsp;Pier Paolo Berti,&nbsp;Vania Pirillo","doi":"10.1016/j.wnsx.2025.100489","DOIUrl":"10.1016/j.wnsx.2025.100489","url":null,"abstract":"<div><div>Franz Anton Mesmer's 18th-century theory of animal magnetism was a fascinating early step in exploring how electromagnetic forces affect the human body. This journey of discovery, full of skepticism and false beliefs has since evolved into the modern practice of using transcranial magnetic stimulation. While Mesmers' persona was portrayed as a deceiver and a weak hypnotist, it can be argued that his ideas partook in laying the groundwork for exploring the relationship between magnetism and human homeostasis. This article introduces the figure of Mesmer, from his humble beginnings as a possible future priest to a beloved founder of a medical treatment philosophy, later disregarded as such by one of the first medical trial in history. This paper continues by analyzing Mesmers' controversial theories and practices and putting it into a perspective with the historical and scientific developments of his time. It introduces the electro-magnetic era from its beginnings to the first controversial therapies such as electroconvulsive shock to its latest application, the transcranial magnetic stimulation. A tool, still in its first stages of medical applications, already being used as a possible treatment for various conditions and as a support for neurosurgical advancements by improving navigation and anatomical mapping in tumor surgery.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100489"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770625","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":"Additive manufacturing for neurosurgical training: Development of patient-specific intracranial aneurysm flexible biomodels","authors":"Lorena Maria Dering ,&nbsp;Eduardo Burkot Hungria ,&nbsp;Jorge Luis Novak Filho ,&nbsp;Matheus Kahakura Franco Pedro ,&nbsp;André Giacomelli Leal ,&nbsp;Mauren Abreu de Souza","doi":"10.1016/j.wnsx.2025.100538","DOIUrl":"10.1016/j.wnsx.2025.100538","url":null,"abstract":"<div><h3>Background</h3><div>Additive manufacturing (AM) technologies have revolutionized the fabrication of three-dimensional objects by sequentially adding material layers based on digital representations. In addition to the production of medical equipment and implants, AM can reproduce precise anatomical models for the visualization of organs and structures, called 3D biomodels. The use of biomodels has the advantages of reducing costs, facilitating communication between doctor and patient, and is also a useful tool for simulation and surgical training.</div></div><div><h3>Methods</h3><div>Five rotational angiography exams of patients with aneurysms were selected. Based on these images, the modeling and 3D printing of biomodels of flexible aneurysms were customized, each model was evaluated based on manufacturing methodology, morphological fidelity compared to digital models, and usability in surgical training.</div></div><div><h3>Results</h3><div>Five IA biomodels, malleable and hollow, were obtained. On average, the production time was 176 min, with an average material cost of US$0.60. In their morphometric analysis, conducted using Geomagic Wrap® software, the biomodels did not demonstrate significant differences in relation to the three-dimensional image of the exam. In the software metrics, the differences between the printed aneurysms and their digital model did not exceed 0.57 mm. The surgical simulation with the biomodels performed by neurosurgeons still in-training and experienced neurosurgeons were positive, validating their use for resident training.</div></div><div><h3>Conclusions</h3><div>The 3D intracranial aneurysm biomodels, produced with flexible resin by 3D printing, demonstrate potential as valuable educational tools for training new professionals in clinical settings.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100538"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145219894","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 effect of pre-stroke physical activity on the initial volume and growth of the brain infarct and the rate of recanalization: A post-hoc analysis of the rescue brain trial","authors":"B. Douma ,&nbsp;M. Ferrigno ,&nbsp;E. Drumez ,&nbsp;B. Lapergue ,&nbsp;C. Rosso ,&nbsp;E. Meseguer ,&nbsp;M.L. Chadenat ,&nbsp;M. Obadia ,&nbsp;C. Hirel ,&nbsp;D.L. Duong ,&nbsp;C. Cordonnier ,&nbsp;P. Amarenco ,&nbsp;F. Pico","doi":"10.1016/j.wnsx.2025.100534","DOIUrl":"10.1016/j.wnsx.2025.100534","url":null,"abstract":"<div><h3>Background</h3><div>– Pre-stroke physical activity is known to influence stroke severity and long-term outcomes. However, its effects on infarct volume and vascular recanalization remain unclear. Using data from the RESCUE BRAIN trial, we aimed to determine whether the beneficial effects of physical activity before stroke are associated with smaller infarct volumes at presentation, reduced infarct growth over 24 h, and/or increased rates of arterial recanalization.</div></div><div><h3>Methods</h3><div><em>–</em> This study is a post-hoc analysis of the RESCUE BRAIN trial, a multicenter, randomized, open-label, controlled trial. Patients for whom information on activity habits was available at the time of randomization were included in this analysis. Hierarchical ascendant clustering was used to define physical activity clusters based on intensity (none, walking, walking and sports), frequency (0, 1, 1–3, &gt;3 times per week), and duration (0, &lt;30, 30–60, &gt;60 min). We examined the associations between physical activity clusters and baseline infarct volume and change in infarct volume over 24 h, site of arterial occlusion, and successful recanalization (including intravenous thrombolysis and mechanical thrombectomy).</div></div><div><h3>Results</h3><div><em>–</em> A total of 151 patients (mean ± standard deviation age 66.3 ± 15.9 years; 47.0 % male) were included. Patients with high levels of pre-stroke physical activity were younger and had a lower prevalence of hypertension (<em>p</em> = 0.02) and atrial fibrillation (<em>p</em> = 0.03). At baseline, infarct volume was unexpectedly larger in the walking and sports cluster (<em>p</em> = 0.01), but there was no significant difference between the three physical activity groups regarding the change in infarct volume at 24 h. We also found no evidence of a difference in baseline cerebral artery occlusion or recanalization rates.</div></div><div><h3>Conclusion</h3><div><em>–</em> This study suggests that pre-stroke physical activity does not affect the change in infarct volume or recanalization rates, despite its impact on the initial infarct size. These findings may suggest that the effects of physical activity may not operate through reducing infarcts volume or improving reperfusion, but rather through other mechanisms.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100534"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145320241","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":"Rational graft selection using the estimated stump pressure ratio in patients with complex internal carotid artery and M1 aneurysms treated with flow-replacement bypass and parent artery sacrifice: Simplifying avoiding the risks of the balloon occlusion test","authors":"Nasaeng Akharathammachote,&nbsp;Kitiporn Sriamornrattanakul,&nbsp;Chanon Ariyaprakai,&nbsp;Atithep Mongkolratnan,&nbsp;Areeporn Chonhenchob","doi":"10.1016/j.wnsx.2025.100522","DOIUrl":"10.1016/j.wnsx.2025.100522","url":null,"abstract":"<div><h3>Background</h3><div>To avoid ischemic complications after vessel sacrifice, universal revascularization is indispensable for treating complex cerebral aneurysms. The selection of the appropriate bypass graft can prevent low-flow–related ischemic stroke (LRIS) after extracranial-to-intracranial (EC-IC) bypass for aneurysms of the internal carotid artery (ICA) and M1 segment of the middle cerebral artery (M1) treated with parent artery sacrifice. Selecting the bypass graft via calculation using the formula proposed by Matsukawa et al requires obtaining the stump pressure ratio (PR) from the preoperative balloon occlusion test (BOT). To avoid BOT complications, we used this formula with the estimated stump PR. We proposed our modified calculation and evaluated its efficacy.</div></div><div><h3>Methods</h3><div>Twenty-three patients who underwent EC-IC bypass and parent artery sacrifice to treat complex ICA and M1 aneurysm were retrospectively evaluated for postoperative LRIS. The bypass graft was selected by calculation using the estimated stump PR.</div></div><div><h3>Results</h3><div>Twelve (52.2 %) and 11 (47.8 %) patients had ICA and M1 aneurysm, respectively. The radial artery, saphenous vein, double superficial temporal artery (STA), and single STA were used in 7 (30.4 %), 3 (13.1 %), 11 (47.8 %), and 2 (8.7 %) patients, respectively. The bypass graft was patent in all patients. No LRIS was detected after operation. Perforator infarctions were found in six patients (26.1 %), but two patients (8.7 %) were symptomatic.</div></div><div><h3>Conclusions</h3><div>The modified calculation using the formula with the estimated stump PR effectively determined an adequate graft size for flow-replacement bypass to treat the ICA and M1 aneurysms without the risk of the BOT.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100522"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044721","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":"Minimally invasive surgery outcomes for intradural extramedullary tumors: a systematic review and meta-analysis","authors":"Ahmer Nasir Baig ,&nbsp;Tabinda Tahir ,&nbsp;Mohammad Hamza Bajwa ,&nbsp;Faiza Urooj ,&nbsp;Aimen Tameezuddin ,&nbsp;Saqib Kamran Bakhshi ,&nbsp;Muhammad Shahzad Shamim","doi":"10.1016/j.wnsx.2025.100544","DOIUrl":"10.1016/j.wnsx.2025.100544","url":null,"abstract":"<div><h3>Introduction</h3><div>Traditionally, spinal intradural-extramedullary (ID-EM) tumors have been accessed via open surgery which involves significant tissue dissection, prolonged time of surgery and painful recovery. Advanced techniques of minimally invasive surgery (MIS) aim to reduce these risks and complications while achieving similar goals of surgery.</div></div><div><h3>Objectives</h3><div>To evaluate and compare surgical, functional, and complication-related outcomes in patients with ID-EM spine tumors receiving surgery through open approaches and MIS.</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines and registered under PROSPERO (#CRD42022302574), a systematic literature search was conducted across PubMed, EBSCO, and the Cochrane Library. Eligible studies included retrospective cohorts and case series that provided comparative data on MIS and open surgical approaches for IDEM tumor excision. Meta-analysis utilized the Mantel-Haenszel random-effects model for pooled data.</div></div><div><h3>Results</h3><div>We reviewed 426 articles and included 16 for qualitative and quantitative analysis. On meta-analysis, a total of 804 patients (372 MIS and 432 open surgery) were included. MIS showed a significant reduction in operative time, intraoperative blood loss, and length of hospital stay. Gross total resection rates were comparable between the two approaches. MIS also resulted in fewer postoperative complications, including cerebrospinal fluid leaks and the need for spinal fusion.</div></div><div><h3>Conclusion</h3><div>MIS for IDEM tumors provides surgical and recovery benefits compared to traditional open surgery, including shorter operative times, reduced blood loss, and fewer postoperative complications. Although both methods achieve similar tumor resection rates, MIS is linked to enhanced patient outcomes and shorter hospital stays, underscoring its role as a viable alternative in managing IDEM tumors. Future research should aim to optimize MIS techniques to improve patient safety and outcomes further.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100544"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145415941","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":"Seizure control after surgical resection of low-grade Gliomas: A Regional retrospective analysis","authors":"Saqib Kamran Bakhshi ,&nbsp;Rabeet Tariq ,&nbsp;Faiza Urooj ,&nbsp;Safwan Masood ,&nbsp;Farhan Arshad Mirza ,&nbsp;Syed Ather Enam","doi":"10.1016/j.wnsx.2025.100548","DOIUrl":"10.1016/j.wnsx.2025.100548","url":null,"abstract":"<div><h3>Introduction</h3><div>Seizures occur in 60–75 % of patients with low-grade gliomas (LGGs). 60–90 % of patients attain seizure freedom after resection. Seizure control varies with histopathology, the extent of resection (EOR), and the type of seizures. There is an inconsistency in the literature regarding the utility of anti-epileptic drugs (AED) after tumor resection. We aimed to determine factors associated with seizure control in patients after LGG resection.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the medical records of all patients who underwent LGG resection at our center from 2018 to 2021. 77 patients fulfilled the selection criteria and were contacted via phone calls to collect information about their seizure control as per Engel Classification. The data was analyzed using SPSSv21.</div></div><div><h3>Results</h3><div>The mean age was 34.9 ± 11.3 years, and there was male predominance (62; 80.5 %). Generalized seizures were the most common type (54; 70 %), and Levetiracetam was the most commonly prescribed AED (60; 77.9 %). The median duration of pre-operative AED use was 4 (IQR: 1–24) months. The frontal lobe was the most common location of tumor (36; 46.8 %). Most of the patients had their surgery under general anesthesia (51; 61.4 %), while 29 (37.7 %) underwent awake craniotomy. Nearly half of the patients had a gross total resection (31; 40.3 %), and another 15 (19.5 %) had near-total resection. Sixteen patients (20.8 %) had their AEDs stopped within the first 6 months post-operatively (at variable intervals), and all of them had Engel Class IA to ID control at the time of follow-up (<em>p</em> = 0.008). The 12 patients with Grade I glioma also had optimum seizure control (<em>p</em> = 0.032).</div></div><div><h3>Conclusion</h3><div>Pilocytic Astrocytomas have better seizure control as compared to Grade II Astrocytomas and Oligodendrogliomas. Further studies are required with larger samples to establish guidelines on achieving adequate postoperative seizure control in LGG patients.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100548"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568495","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":"A randomized trial comparing the effects of single-dose preemptive ketorolac and dexamethasone on postoperative pain and morphine consumption following lumbar laminectomy","authors":"Terdsak Phonchan,&nbsp;Surachai Sae-Jung","doi":"10.1016/j.wnsx.2025.100498","DOIUrl":"10.1016/j.wnsx.2025.100498","url":null,"abstract":"<div><h3>Background</h3><div>Lumbar laminectomy is a common surgical option for treating lumbar stenosis, but it can result in moderate to severe pain. Proper pain management is important for patients to recover quickly. This randomized trial aimed to compare ketorolac and dexamethasone for postoperative pain and morphine use in lumbar laminectomy patients.</div></div><div><h3>Methods</h3><div>This study included 120 patients, ranging in age from 18 to 75 years old, who underwent lumbar laminectomy. The patients were randomly assigned to either the ketorolac or dexamethasone group. The study aimed to evaluate two main factors: the amount of morphine used and the pain levels measured by the visual analog scale (VAS) at specific times after surgery, including the post-anesthetic care unit (PACU), as well as at 12, 24, and 48 h following the procedure. Furthermore, any adverse events that occurred during the study were thoroughly recorded.</div></div><div><h3>Results</h3><div>After 48 h, the patients who were given ketorolac required less morphine than those in the dexamethasone group (<em>p</em>-value = 0.01). However, patients in the dexamethasone group had lower VAS scores than those in the ketorolac group after 24 h (<em>p</em>-value = 0.01). Importantly, no serious adverse events occurred, including respiratory depression and surgical site infections.</div></div><div><h3>Conclusions</h3><div>After a lumbar laminectomy procedure, a single preemptive dose of ketorolac showed a slight decrease in postoperative morphine usage 48 h later when compared to dexamethasone. However, there was no noticeable effect on the patient's pain scores.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100498"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144738756","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}