World Neurosurgery: X最新文献

{"title":"Predictive factors of resolution of cranial nerve disfunction in symptomatic patients with intra-cavernous carotid aneurysms treated with ICA occlusion and by-pass procedure","authors":"Daniele Armocida ,&nbsp;Francesco Paglia ,&nbsp;Alessandro Frati ,&nbsp;Antonio Santoro","doi":"10.1016/j.wnsx.2025.100510","DOIUrl":"10.1016/j.wnsx.2025.100510","url":null,"abstract":"<div><h3>Background</h3><div>Aneurysms of the cavernous segment of the internal carotid artery (cICA) frequently present with cranial nerve disfunctions (CNDs). The resolution of the CNDs could be guarantee with the occlusion of the proximal ICA and by-pass surgery. It is actually unknown how the type of surgical procedure and which factors have an impact on post-operative symptom relapse in CND.</div></div><div><h3>Methods</h3><div>We reviewed the clinical results related to the resolution of CNDs in 24 surgically-treated patients with symptomatic cICAs focusing on the difference between the treatment with high-flow or low-flow bypass.</div></div><div><h3>Results</h3><div>17 patients underwent to surgical treatment of ICA-exclusion with high-flow IC–IC by-pass and 7 patients with low-flow EC-IC by-pass. We divided the series into a group whose symptoms disappeared (improved group) or remained (Residual/worse group). Patients’ mean age was significantly younger in the improved group than in the residual/worse group (45.1 versus 56.62, <em>p</em> = 0.047). We found no significant relationship between the choice of bypass technique with the presence of aneurysm recurrence (<em>p</em> = 0.364), the performance status at follow-up and clinical improvement of CND (<em>p</em> = 0.65).</div></div><div><h3>Conclusions</h3><div>Surgical occlusion of the ICA with bypass is safe and effective in treating symptomatic iCAs, showing no significant differences with the type of technique used (low- or high-flow bypasses). The main factors in the resolution of CND after the treatment of cICA are age, size, clinical disability and surgery-timing.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100510"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913138","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":"Application of a SQUIRE-compliant framework to improve patient management decision-making quality for microsurgery versus endovascular treatments in ruptured intracranial aneurysms","authors":"Yao Christian Hugues Dokponou,&nbsp;Mahjouba Boutarbouch,&nbsp;Yasser Arkha,&nbsp;Adyl Melhaoui,&nbsp;Mohammed Yassaad Oudrhiri,&nbsp;Mehdi Hakkou,&nbsp;Abdessamad El Ouahabi","doi":"10.1016/j.wnsx.2025.100506","DOIUrl":"10.1016/j.wnsx.2025.100506","url":null,"abstract":"<div><h3>Background</h3><div>Rupture of intracranial aneurysm results in a potentially life-threatening subarachnoid hemorrhage (SAH) leading to a 45 % mortality rate with only 30 % returning to their normal life. Thus, the management decision is crucial. This study aimed to improve consistency, patient-centeredness, safety, and effectiveness of the decision-making for microsurgical or endovascular treatments of intracranial aneurysms (IAs) patients by appraisal of clinical, locational, and morphometric factors.</div></div><div><h3>Methods</h3><div>We use the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines to guide the appraisal of 394 patients with 435 IAs for quality improvement of aSAH treatment decision making. Between January 2013 and December 2022, our team developed a flexible patient selection criterion for microsurgical or endovascular treatments of ruptured IAs.</div></div><div><h3>Results</h3><div>We depicted 312 (71.7 %) and 123 (28.3 %) anterior cerebral circulation IAs and posterior cerebral circulation IAs respectively. About 65.5 %(n = 285) were clipped whereas 34.5 %(n = 150) underwent coiling. Multiple factors (age, location, type, size, dome-to-neck ratio, WFNS grade at admission, and modified Rankin Scale “mRS” score) were found to influence the quality-improving decision-making for microsurgery or endovascular treatment of IAs. There was a statistically significant difference (p &lt; 0.001) between the aneurysmal morphometric factors for clinical decision of endovascular treatments (42 % vs 58 %) or microsurgical clipping (78.9 % vs 21.1 %) of the anterior and posterior cerebral circulation IAs respectively, with an Odds ratio 2.72; 95 %CI [1.76–4.18].</div></div><div><h3>Conclusion</h3><div>Despite the management of IA's for many decades, reliable indicators for making decisions on microsurgical versus endovascular treatments for IA's are still debated.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100506"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144908697","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 comparative analysis of suturectomy versus remodeling in non-syndromic craniosynostosis: A systematic review and meta-analysis","authors":"Tjokorda Istri Sri Dalem Natakusuma ,&nbsp;Bryan Gervais de Liyis ,&nbsp;Kadek Dede Frisky Wiyanjana ,&nbsp;Sri Maliawan ,&nbsp;Tjokorda Gde Bagus Mahadewa","doi":"10.1016/j.wnsx.2025.100526","DOIUrl":"10.1016/j.wnsx.2025.100526","url":null,"abstract":"<div><h3>Background</h3><div>Non-syndromic craniosynostosis, involving premature fusion of isolated cranial sutures, is managed surgically by either minimally invasive strip suturectomy or open cranial vault remodeling. Although individual cohort studies have described perioperative metrics and cranial index improvements for each technique, no meta-analysis has systematically compared their relative efficacy, safety, and morphologic impact across different suture types, leaving optimal procedural selection unresolved. This meta-analysis evaluates postoperative outcomes and complications of suturectomy versus cranial remodeling in pediatric patients with non-syndromic craniosynostosis.</div></div><div><h3>Methods</h3><div>Systematic searches of ScienceDirect, MEDLINE, Embase, and CENTRAL databases identified cohort studies up to October 2024 (PROSPERO ID: CRD42024606734). Postoperative outcomes included cephalic index (CI), interfrontal angle (IFA), interzygomaticofrontal distance (IZFD), and complications. Intraoperative outcomes encompassed operation time, estimated blood loss, hospital stay, revision surgeries, and transfusion requirements.</div></div><div><h3>Results</h3><div>This meta-analysis included 25 cohort studies with 3344 children (mean age 8.10 ± 3.34 months), divided into the suturectomy group (1424 children) and the remodeling group (2099 children). The suturectomy group showed significant advantages: shorter operation time (MD:-143.18; 95 %CI:- 180.06 to −106.29; <em>p</em> &lt; 0.001), reduced estimated blood loss (MD:-221.17; 95 %CI:-305.41 to −136.90; <em>p</em> &lt; 0.001), shorter hospital stay (MD:-2.58; 95 %CI:-3.07 to −2.09; <em>p</em> &lt; 0.001), lower revision surgeries (RR:0.31; 95 %CI:0.13–0.72; <em>p</em> = 0.01), decreased blood transfusion (RR:0.01; 95 %CI:0.00–0.05; <em>p</em> &lt; 0.001), and fewer complications (RR:0.28; 95 %CI:0.09–0.89; <em>p</em> = 0.03). In the suturectomy group, CI (MD:0.06; 95 %CI:0.03–0.08; <em>p</em> &lt; 0.001) and IFA (MD:12.05; 95 %CI:6.62–17.47; <em>p</em> &lt; 0.001) improved significantly, while IZFD did not. In the remodeling group, CI (MD:0.05; 95 %CI:0.02–0.08; <em>p</em> &lt; 0.001) and IFA (MD:13.47; 95 %CI:9.58–17.91; <em>p</em> &lt; 0.001) also improved, but IZFD showed no significant change. Cranial indices were not significantly different between both groups.</div></div><div><h3>Conclusions</h3><div>Suturectomy offers better intraoperative outcomes, with reduced operative time, blood loss, hospital stay, revision surgeries, blood transfusion, and complications, making it ideal for younger, single-suture cases. Cranial indices were found to be similar following both interventions.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100526"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of a nomogram model based on spinopelvic parameters for predicting recurrent lumbar disc herniation","authors":"Tengyu Wang,&nbsp;Conggang Liao,&nbsp;Yufei Jin,&nbsp;Keyu Luo,&nbsp;Xiang Yin","doi":"10.1016/j.wnsx.2025.100545","DOIUrl":"10.1016/j.wnsx.2025.100545","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the predictive value of spinopelvic parameters and clinical variables for recurrent lumbar disc herniation (rLDH) following percutaneous endoscopic lumbar discectomy (PELD).</div></div><div><h3>Methods</h3><div>We retrospectively collected data from 1219 patients who underwent PELD surgery between January 2017 and January 2023, randomly divided into training (70 %) and validation (30 %) groups. Univariate and multivariate logistic regression analyses were performed in the training set to identify independent risk factors and construct a nomogram model. Model accuracy was assessed using the area under the receiver operating characteristic curve (AUC). Calibration was evaluated through calibration curves and goodness-of-fit tests. Decision curve analysis (DCA) was performed to assess net clinical benefit.</div></div><div><h3>Results</h3><div>Multivariate analysis identified BMI ≥25 kg/m², high-intensity labor, pelvic incidence (PI) &lt;45° or &gt;60°, sacral slope (SS) &lt; 35°, Pfirrmann grade III, and Modic type II and III changes as independent predictors of rLDH (<em>p</em> &lt; 0.05). The model achieved an AUC of 0.836 (95 %CI: 0.801–0.872) in the training set and 0.812 (95 %CI: 0.735–0.888) in the validation set. Calibration curves showed good agreement between predicted and observed values. DCA demonstrated that the model provided significant net clinical benefit when intervention threshold probabilities were set at 2 %–59 % for the training set and 2 %–45 % for the validation set.</div></div><div><h3>Conclusion</h3><div>The spinopelvic parameter-based nomogram prediction model demonstrated excellent predictive performance for rLDH after PELD and facilitates individualized risk assessment.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100545"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145464886","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":"Management strategies for arachnoid cysts presenting with subdural hygromas: Literature review","authors":"Ahmed M. Assar ,&nbsp;Seif Tarek El-Swaify ,&nbsp;Mohamed A. Bashir ,&nbsp;Ahmed Reda ,&nbsp;Yasser O. Riyad","doi":"10.1016/j.wnsx.2025.100528","DOIUrl":"10.1016/j.wnsx.2025.100528","url":null,"abstract":"<div><div>Arachnoid cysts (ACs) are identified in 1–2 % of the population through intracranial imaging. A possible complication of arachnoid cysts (ACs) is their rupture, which can lead to the development of a subdural hygroma (SDG). Currently, there is no consensus on management strategies for these patients. We present a comprehensive literature review of this topic. Our bibliographic database search (PubMed) identified 55 studies published between 1983 and 2023, encompassing data on 148 patients. The mean age was 12.3 years. Most patients were male (76.5 %). 71 patients had a history of trauma. The middle cranial fossa was the most common site for ACs (<em>n</em> = 146), with 52.7 % occurring on the left side. According to Galassi classification, 35.6 % (<em>n</em> = 52) were type 2 cysts. Most authors opted for operative management of symptomatic cases, typically involving hygroma evacuation and cyst fenestration into basal cisterns. Our review of the literature revealed that, the most prevalent surgical approach was craniotomy with microscopic cyst fenestration, which was performed in 29 cases. Conversely, burr holes with endoscopic cyst fenestration were utilized in 20 cases. A conservative follow-up strategy was adopted in 18 cases. The mean post-operative follow-up period was 2.5 years. Ruptured ACs complicated by SDGs are infrequently encountered in neurosurgical practice, complicating the development of standardized treatment protocols. Thus, management should be individualized.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100528"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157634","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":"EC-IC direct bypass revascularization for intracranial atherosclerosis. Insights beyond the COSS trial","authors":"Carlos Santos ,&nbsp;Helena Calvo-Rubio ,&nbsp;Dario Gandara ,&nbsp;Carles Lorenzo-Bosquet ,&nbsp;Marta Rubiera ,&nbsp;Silvia Vazquez ,&nbsp;Alejandro Tomasello ,&nbsp;Fuat Arikan","doi":"10.1016/j.wnsx.2025.100496","DOIUrl":"10.1016/j.wnsx.2025.100496","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite the results of the EC-IC Bypass International Trial and the Carotid Occlusion Surgery Study (COSS), high-volume centers continue to treat symptomatic intracranial atherosclerotic patients with bypass revascularization. This study aimed to analyze our data and assess whether patient characteristics and outcomes differ from those in EC-IC Bypass and COSS trials.</div></div><div><h3>Methods</h3><div>Patients with intracranial atherosclerotic occlusions treated by EC-IC bypass from January 2012 to June 2022 were included. Inclusion criteria were: (1) intracranial atherosclerotic occlusion &gt;70 %, (2) transient or permanent ischemic events in the affected territory, and (3) impaired cerebrovascular reactivity demonstrated by acetazolamide-challenged SPECT.</div></div><div><h3>Results</h3><div>Forty-nine patients were included. Half presented bilateral occlusions, and 53.1 % had hemodynamic symptoms. Most were asymptomatic or had mild strokes preoperatively. Postoperatively, mRS worsened in 34.78 % of patients without hemodynamic symptoms, compared to 15 % of symptomatic patients. No significant differences in NIHSS or mRS were observed between pre- and postoperative evaluations. The 30-day complication rate was 20.4 %, with one procedure-related death. High rates of bypass patency (97.95 %) and SPECT improvement (87.75 %) were achieved. Long-term ipsilateral ischemic stroke rate was 2 %.</div></div><div><h3>Conclusion</h3><div>EC-IC bypass remains a viable option in carefully selected patients with symptomatic intracranial stenosis and impaired cerebrovascular reserve. Patient selection based on clinical and functional criteria is essential. Our results contrast with those of the COSS trial, showing lower recurrence of ipsilateral ischemic stroke, neurological stability in most patients, and favorable outcomes in individuals with hemodynamic symptoms and contralateral stenosis.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100496"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687555","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":"Recurrence rate of chronic cerebral arterial occlusion with mean transit time more than 6 s: a case series","authors":"Ittipon Gunnarut ,&nbsp;Kritsada Buakate ,&nbsp;Nisarat Phatisuwan","doi":"10.1016/j.wnsx.2025.100497","DOIUrl":"10.1016/j.wnsx.2025.100497","url":null,"abstract":"<div><h3>Objective</h3><div>Chronic cerebral arterial occlusion and stenosis are significant medical conditions which can cause hemodynamic impairment, leading to symptoms such as transient ischemic attacks and progressive or recurrent strokes. Surgical bypass is a treatment modality available for these conditions, but its results are only similar to those of the best medical treatment. The CMOSS study analyzed a subgroup of patients receiving the best medical treatment and found that individuals with prolonged mean transit time may benefit from the surgical bypass procedure.</div><div>The objective of this report was to investigate the recurrence rate of unilateral chronic cerebral arterial occlusion with a mean transit time of more than 6 s treated with STA-MCA by-pass procedure during the follow-up period.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted between January 2010 and December 2024 at Rajavithi Hospital, including patients who received the best medical treatment, had a mean transit time (MTT) greater than 6 s, and also had a relative cerebral blood flow (rCBF) of ≤0.5 m. All patients underwent STA-MCA bypass surgery. Data collected included demographic information, recurrence rates, pre- and post-operative Glasgow Coma Scores, and modified Rankin Scores.</div></div><div><h3>Results</h3><div>The demographic data of the predominantly male patients showed a mean age of 57.2 years. Regarding CT perfusion, all patients had an MTT greater than 6 s, and 93.3 % had an rCBF below 0.5. The postoperative results indicated that the modified Rankin Scale (MRS) was similar to the preoperative condition, but also that 80 % of symptoms improved. The recurrence rate was 0 % during the follow-up period; however, 3 patients died, and the cause of death in all cases was pneumonia (not due to ipsilateral stroke).</div></div><div><h3>Conclusion</h3><div>This report demonstrates that STA-MCA bypass is potentially useful for patients with single-vessel chronic ICA/MCA stenosis or occlusion who do not respond to the best medical treatment, as indicated by CT perfusion showing an MTT &gt;6 s and an rCBF ≤0.5.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100497"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144703155","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":"Freehand ventricular catheter placement in ventriculoperitoneal shunt surgery is associated with higher rates of proximal catheter failure compared to image guidance","authors":"Nikhil Sharma ,&nbsp;Jeffery R. Head ,&nbsp;Regan M. Shanahan ,&nbsp;Shovan Bhatia ,&nbsp;Michael R. Kann ,&nbsp;Sydney Scanlon ,&nbsp;Amogh Vellore ,&nbsp;Michael Raver ,&nbsp;Hussam Abou-Al-Shaar ,&nbsp;Nicolas M. Kass ,&nbsp;Fritz Steuer ,&nbsp;Lucille Cheng ,&nbsp;Stephen P. Canton ,&nbsp;Arka N. Mallela ,&nbsp;Peter C. Gerszten ,&nbsp;Edward G. Andrews","doi":"10.1016/j.wnsx.2025.100505","DOIUrl":"10.1016/j.wnsx.2025.100505","url":null,"abstract":"<div><h3>Objective</h3><div>Ventricular catheter (VC) revision due to proximal catheter failure is a well-known but potentially avoidable complication of ventriculoperitoneal shunting (VPS). Anatomical “freehand” VC placement is still commonplace, despite image guidance availability. We sought to determine the impact of freehand versus image-guided VC placement on accuracy and consequent revision rates.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of all consecutive adult VPS procedures performed at a single hospital during a two-year period. Only frontal shunts and first-time cannulations of a ventricle were included. Accuracy was measured by linear distance from the catheter tip to the Foramen of Monro (Tip to Foramen, TTF) and Kakarla Grade (KG).</div></div><div><h3>Results</h3><div>Sixty patients met inclusion criteria, with a mean age of 54.1 ± 15.9 years. Most VCs were placed with the freehand technique (<em>n</em> = 40, 66.7 %), with all revisions (100 %) placed using freehand technique. Use of image guidance significantly increased accurate VC placement by TTF (7.6 ± 6.0 mm vs. 16.1 ± 8.2 mm, <em>p</em> &lt; 0.001) and KG (KG1; 85 % vs. 35 %, <em>p</em> = 0.001), without increasing procedure length (74.8 ± 24.1min vs. 82.3 ± 38.7min, <em>p</em> = 0.219). Four shunts (6.67 %) required VC revision, all within 10 days of surgery. VCs requiring revision were placed significantly less accurately (26.8 ± 9.6 mm vs. 12.02 ± 7.46 mm, <em>p</em> &lt; 0.001). VCs with TTF &gt;2 cm had a significantly higher rate of proximal revision (30 % vs. 2.0 %, <em>p</em> = 0.001).</div></div><div><h3>Conclusion</h3><div>Image-guided placement increases accuracy of proximal shunt catheter placement without sacrificing operative efficiency. VC revision is associated with inaccurate placement and highly inaccurate VCs (&gt;2 cm TTF) are more likely to require revision in the immediate post-operative period.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100505"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144888799","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":"Microsurgical treatment of recurrent and residual previously clipped/or coiled intracranial aneurysms: a single center series of 22 patients","authors":"Jo Ee Sam ,&nbsp;Dragan Janković ,&nbsp;Yasuhiro Yamada ,&nbsp;Riki Tanaka ,&nbsp;Kento Sasaki ,&nbsp;Takamitsu Tamura ,&nbsp;Fuminari Komatsu ,&nbsp;Yoko Kato","doi":"10.1016/j.wnsx.2025.100503","DOIUrl":"10.1016/j.wnsx.2025.100503","url":null,"abstract":"<div><h3>Objective</h3><div>Recurrent and residual intracranial aneurysms (RA) are encountered with both clipping and endovascular treatment, and microsurgical treatment may be the only option at times. We present a series of 22 patients with RA that underwent microsurgical treatment, emphasizing on treatment strategies, occlusion rate, durability, and outcome.</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of 22 patients with 23 RA treated with microsurgery. There was a total of 11 previously coiled and 12 previously clipped aneurysms. Data on demography, previous treatments, aneurysm characteristics, surgical indications, microsurgical treatment strategy, post-surgical occlusion rate, durability of treatment, complications, and functional outcome were collected.</div></div><div><h3>Results</h3><div>Clipping was performed on 21 (91.3 %) aneurysms, clipping and bypass on 1 aneurysm, and trapping and bypass on 1 aneurysm. Complete occlusion was achieved with 22 (95.7 %) aneurysms. Previous coils were removed in one case and previous clips were removed in 4 cases. One patient that had previous coiling and 2 patients that had previous clipping suffered complications. Good functional outcome was achieved for all retreated cases except one. Median follow-up was 5 years and no recurrence has been detected so far.</div></div><div><h3>Conclusion</h3><div>Outcome for microsurgical retreatment of RA is good provided proper selection of cases and treatment strategy is adhered to. The best clinical judgement is needed to prevent unnecessary morbidity from retreatment or a catastrophic rupture from a delay in retreatment. Ideally, the most efficient strategy to deal with RA is to prevent their occurrence altogether during the primary treatment as RA are definitely harder to treat compared to virgin aneurysms.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100503"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144813980","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":"Could recent advances improve the survival times and quality of life for sacral and mobile spine chordomas? A systematic review and meta-analysis","authors":"Bilal Bahadır Akbulut ,&nbsp;Mehmet Zileli ,&nbsp;Habib Canberk Karakoç","doi":"10.1016/j.wnsx.2025.100499","DOIUrl":"10.1016/j.wnsx.2025.100499","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review and meta-analysis evaluated whether recent advances have improved survival outcomes for sacral and mobile spine chordomas, examining the necessity of radical surgical resection, efficacy of modern radiotherapy techniques, and potential for biomarkers to predict outcomes.</div></div><div><h3>Methods</h3><div>We systematically searched English-language literature from 2004 to 2024, and of the 202 initially identified studies, 39 met the inclusion criteria for meta-analysis. We performed <em>Z</em>-test analysis and meta-analysis of overall survival (OS) and progression-free survival (PFS) at 5 and 10 years across three domains: treatment modalities (<em>n</em> = 31), surgical margins (<em>n</em> = 26), and radiotherapy modalities (<em>n</em> = 18).</div></div><div><h3>Results</h3><div>Five-year OS rates were 79 % for surgery alone, 82 % for radiotherapy alone, and 80 % for combined therapy. Negative margins were associated with lower local recurrence rates; however, overall survival did not differ significantly between negative and positive margins (83 % vs. 74 % five-year OS). Extensive resections for negative margins resulted in higher complication rates and negatively impacted quality of life. Proton beam therapy showed superior survival rates compared to conventional radiotherapy (85 % vs. 70 %, <em>p</em> = 0.012), although 10-year data remain unavailable. Biomarker and histopathological prediction methods, as well as chemotherapy approaches, lack standardization.</div></div><div><h3>Conclusions</h3><div>Recent advances in chordoma management have improved survival outcomes, with radiotherapy, particularly proton beam therapy, emerging as an effective primary or adjuvant treatment. Surgical margins do not significantly impact overall survival, which raises questions about the necessity of radical resections and their associated morbidity. While promising biomarkers and targeted therapies are under investigation, standardized protocols for predicting outcomes and administering systemic therapy remain to be established.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"28 ","pages":"Article 100499"},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144766856","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}