Neurocirugia最新文献

{"title":"Asociaciones entre las características de imagen y el riesgo de trastorno de estrés postraumático en la lesión cerebral traumática: análisis de la localización de la hemorragia y la afección en la resonancia magnética","authors":"Barbara Buccilli","doi":"10.1016/j.neucir.2025.500742","DOIUrl":"10.1016/j.neucir.2025.500742","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injury (TBI) can lead to post-traumatic stress disorder (PTSD), with risk factors potentially linked to injury characteristics visible on imaging. This study examines associations between PTSD at 6 months and two imaging features: bleed location (epidural, subdural, subarachnoid, and contusions) and MRI pathology.</div></div><div><h3>Methods</h3><div>Using data from the TRACK-TBI Pilot Dataset, we analyzed imaging characteristics and PTSD status in 586 patients. Bleed types and MRI results were assessed in relation to PTSD rates at 6 months. We applied logistic regression for bleed locations and chi-square testing for MRI findings to determine statistical significance.</div></div><div><h3>Results</h3><div>Bleed location did not significantly predict PTSD at 6 months. Logistic regression analysis showed no significant association between specific bleed types (epidural, subdural, subarachnoid, or contusions) and PTSD risk (<em>p</em> <!-->&gt;<!--> <!-->0.05 for all bleed types). However, MRI findings showed a statistically significant association with PTSD status (<em>p</em> <!-->=<!--> <!-->0.048). Patients with positive MRI findings indicating pathology had a lower PTSD prevalence (20.9%) compared to those with negative MRI findings (36.7%) or uncertain findings, where no PTSD cases were observed.</div></div><div><h3>Conclusion</h3><div>While bleed location is not significantly associated with PTSD risk, MRI results suggest a possible link between brain pathology and PTSD outcomes, with positive MRI findings associated with a lower prevalence of PTSD. These findings highlight the complex relationship between TBI imaging characteristics and PTSD risk, suggesting that MRI pathology may serve as a marker for differential PTSD outcomes. Future studies should explore underlying mechanisms and integrate clinical, genetic, and imaging data to refine PTSD risk assessment in TBI patients.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500742"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El laboratorio experimental en el desarrollo y la evolución de la neurocirugía: perspectiva histórica en homenaje al profesor G. Yasargil","authors":"Giancarlo Mattos Piaggio,&nbsp;Emilio González Martínez,&nbsp;David Santamarta Gómez,&nbsp;Javier Ibáñez Plágaro,&nbsp;José García-Cosamalón","doi":"10.1016/j.neucir.2025.500727","DOIUrl":"10.1016/j.neucir.2025.500727","url":null,"abstract":"<div><div>The experimental laboratory has been of paramount importance in the development and evolution of neurosurgery. In that research environment, many neurosurgical techniques were designed and the classics approaches to different regions of the brain were refined, until turning neurological surgery into atraumatic procedure, fulfilling one of the founding axioms of this speciality, that of delicate treatment on brain tissue, advocated by Harvey Cushing and later optimized by professor Gazy Yasargil. The scenarios, their main characters, and the contributions they made to the development and progress of neurosurgery have all been analyzed in this article from a historical standpoint.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500727"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"El momento en que se realiza la cementación vertebral en fracturas aplastamiento toracolumbares importa: impacto en alivio del dolor, fuga de cemento y progresión del aplastamiento","authors":"Raquel Gutiérrez-González ,&nbsp;Teresa Kalantari ,&nbsp;Xavier Santander ,&nbsp;Álvaro Zamarrón ,&nbsp;Ana Royuela","doi":"10.1016/j.neucir.2025.500744","DOIUrl":"10.1016/j.neucir.2025.500744","url":null,"abstract":"<div><h3>Background and aim</h3><div>There is no consensus regarding the best timing of vertebral augmentation (VA) procedures for the treatment of osteoporotic thoracolumbar fractures. This study aims to determine if early VA (performed during the first 2 weeks of evolution) show an advantage over delayed surgery in terms of efficacy and safety outcomes, and to evaluate the role of different modifiable therapeutic variables on the same outcomes.</div></div><div><h3>Material and methods</h3><div>Single-center retrospective study including all patients aged &gt;50 years who underwent VA for thoracolumbar osteoporotic fracture from 2010 to 2023. Patients with two events in less than 3 months or incomplete follow-up were excluded. Pain relief, fracture progression and cement extravasation were assessed with regression analyses.</div></div><div><h3>Results</h3><div>One hundred fifty-four procedures were analyzed, with no significant difference in pain relief according to the timing of surgery. Early VA (1–14 days after symptoms onset) was associated with higher risk of fracture progression compared to intermediate (15–60 days; OR 15.2, <em>p</em> <!-->=<!--> <!-->0.001) and delayed (&gt;60 days; OR 16.2, <em>p</em> <!-->=<!--> <!-->0.013) procedures; higher risk of cement leakage into the disc or vascular space (OR 3.2, <em>p</em> <!-->=<!--> <!-->0.025); but lower risk of spinal canal cement leakage (OR 0.16, <em>p</em> <!-->=<!--> <!-->0.027). No differences were observed between vertebroplasty and kyphoplasty.</div></div><div><h3>Discussion and conclusion</h3><div>Early VA showed equivalent but earlier effect on pain relief and reduced risk of spinal canal leakage when compared with delayed procedures, despite a non-clinically significant increased risk of fracture progression and cement leakage into the disc or drainage vessels. Thus, it was identified as the most effective strategy for balancing analgesic efficacy and procedural safety.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500744"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posición semisentada en neurocirugía: experiencia de 20 años en un centro terciario","authors":"Duygu Dolen Burak ,&nbsp;Cafer Ikbal Gulsever ,&nbsp;Merve Erguven ,&nbsp;Alperen Poyraz ,&nbsp;Ilyas Dolas ,&nbsp;Pulat Akin Sabanci","doi":"10.1016/j.neucir.2025.500734","DOIUrl":"10.1016/j.neucir.2025.500734","url":null,"abstract":"<div><h3>Introduction</h3><div>The semisitting position offers surgical advantages for posterior fossa and pineal region procedures but remains controversial due to potential complications such as venous air embolism (VAE) and tension pneumocephalus. This study reviews a 20-year single-center experience to assess its safety, complication profile, and clinical outcomes under a standardized monitoring protocol.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study included all consecutive patients undergoing neurosurgical procedures in the semisitting position at our tertiary center from January 2004 to December 2024. Patients were monitored using a standardized protocol including precordial Doppler ultrasonography, end-tidal CO₂ monitoring, and central venous catheter placement. Patient demographics, surgical details, perioperative complications, and clinical outcomes were systematically analyzed. Venous air embolism (VAE) and other significant adverse events were specifically documented. Statistical analyses included univariate and multivariate logistic regression analyses to identify potential risk factors for complications.</div></div><div><h3>Results</h3><div>A total of 244 patients underwent surgery in the semisitting position, with a mean age of 43.8<!--> <!-->±<!--> <!-->18.4 years. The most common surgical localizations were the parietal and occipital regions, followed by the posterior fossa. The incidence of VAE was 4.5% (<em>n</em> <!-->=<!--> <!-->11), including one fatal cerebral infarction. Other complications occurred in 3.6% of cases, including tension pneumocephalus (1.6%), neurological deficit, cerebrospinal fluid leakage, postoperative seizure, myocardial infarction, and ischemic infarction (each 0.4%). Multivariate analysis did not identify significant predictors of complications.</div></div><div><h3>Conclusions</h3><div>The semisitting position remains a safe and effective neurosurgical approach when executed with rigorous protocols and vigilant monitoring. With careful management, these risks can be effectively mitigated, underscoring their continued utility in suitable cases, particularly for surgeries involving the posterior fossa and pineal region.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500734"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Técnica de reparación con hemoclip: evaluación preliminar de un método seguro y práctico para el cierre de la duramadre en la hemilaminectomía","authors":"Mehmet Aktoklu,&nbsp;Mehmet Orbay Bıyık,&nbsp;Ali Samet Topsakal,&nbsp;Ali Rıza Güvercin,&nbsp;Ertuğrul Çakır,&nbsp;Yağmur Kurak","doi":"10.1016/j.neucir.2025.500730","DOIUrl":"10.1016/j.neucir.2025.500730","url":null,"abstract":"<div><h3>Purpose</h3><div>In the surgical management of spinal tumours, haemilaminectomy is frequently the preferred approach due to its minimal invasive nature and the ability to preserve stability. However, the repair of the dura mater defect is technically very difficult and a challenging problem for neurosurgeons because of the high incidence of complications related to postoperative cerebrospinal fluid (CSF) leakage. This study presents a novel haemoclip-assisted technique that has been developed for the purpose of providing s</div><div>afe and rapid dura repair in spinal tumour surgery involving haemilaminectomy.</div></div><div><h3>Material and methods</h3><div>In 12 patients who underwent haemilaminectomy for spinal intradural extramedullary tumours between 2023 and 2024, dura mater defects were repaired with haemoclips. The technique is to present the results of cases in which the dura edges were closed with non-penetrating haemoclips. The results were evaluated in terms of dura repair time, postoperative complications and presence of CSF leakage.</div></div><div><h3>Results</h3><div>The mean dural repair time was found to be significantly shorter when compared to conventional suture methods. Postoperative cerebrospinal fluid leakage and related complications were not observed in any patient. The technique significantly facilitated surgical practice, especially in the haemilaminectomy window, which provides a limited field of view. Furthermore, the absence of artefacts in magnetic resonance imaging (MRI) appears to be a significant additional criterion in patient follow-up.</div></div><div><h3>Conclusion</h3><div>Haemoclip-assisted dura repair is a safe, fast and practical alternative for spinal tumour surgery with haemilaminectomy. The technique has the potential to reduce complication rates by facilitating dura repair.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500730"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisión sistemática de la hernia discal intradural: perspectiva de un neurocirujano","authors":"Alberto Morello,&nbsp;Enrico Lo Bue,&nbsp;Ayoub Saaid,&nbsp;Stefano Colonna,&nbsp;Alessandro Pesaresi,&nbsp;Federica Bellino,&nbsp;Marco Ajello,&nbsp;Alessandro Fiumefreddo,&nbsp;Diego Garbossa,&nbsp;Fabio Cofano","doi":"10.1016/j.neucir.2025.500743","DOIUrl":"10.1016/j.neucir.2025.500743","url":null,"abstract":"<div><div>Intradural disk herniation (IDH) refers to the protrusion of the nucleus pulposus into the dural sac. While disk herniation is a relatively frequent condition, the intradural variant is exceptionally rare. Patients diagnosed with IDH often exhibit more pronounced clinical symptoms compared to those with extradural herniations. Establishing a definitive preoperative diagnosis remains challenging, as the pathophysiology and radiological features are not yet fully understood. Differentiating IDH from other intradural extramedullary pathologies, including schwannomas, neurofibromas, meningiomas, or metastatic lesions, can be complex.</div><div>A systematic review was conducted on the diagnosis and treatment of cervical, thoracic and lumbar IDH, following PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and retrieving potentially relevant literature from PubMed and Embase. The search strategy included combinations of the terms “transdural” OR “intradural” AND “disc” AND “herniation”. Age, sex, symptoms, herniated disk level, history of trauma, location of disk mass, imaging examination, pre- or intraoperative diagnosis and clinical outcomes were studied through the medical records. The type of surgery, the ventral dural defect management and the postoperative leakage of cerebrospinal fluid were also evaluated.</div><div>One hundred and sixty-one articles involving 285 patients were selected. Cases of IDHs occurred at the lumbar (64.3%), thoracic (21.9%) and cervical (13.8%) levels. The most common level IDH was located at L4–L5 (27.6%). 49 patients exhibited cauda equina syndrome. Only 44 patients (15.4%) were diagnosed as having IDH preoperatively, while most patients were diagnosed intraoperatively. Neurological functions improved variably according to cervical, thoracic and lumbar locations (respectively 2.5%, 5.6% and 21.7%).</div><div>IDH mostly involves the lumbar spine. Patients with IDH generally experience more severe symptoms than those with extradural disk herniation and have incomplete recovery of postoperative neurological functions. Diagnosing IDH remains challenging given its clinical presentations and radiographic features, and it is likely an underdiagnosed and underestimated condition.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500743"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"¿Síndrome de espalda fallida o ciática extrarraquídea? Síndrome isquiofemoral como causa de dolor radicular persistente tras 4 cirugías de columna lumbar","authors":"Andrés Barriga Martín ,&nbsp;Orlando Paredes Muñóz ,&nbsp;Miguel Peral Alarma ,&nbsp;Luis María Romero Muñóz ,&nbsp;Joint Halley Guimbard Pérez","doi":"10.1016/j.neucir.2025.500737","DOIUrl":"10.1016/j.neucir.2025.500737","url":null,"abstract":"<div><div>Most cases of sciatica are caused by compression of lumbar nerve roots, although some originate from extraradicular structures, such as in ischiofemoral impingement syndrome. We present the case of a 64-year-old man with a 10-year history of right-sided sciatic pain occurring only while seated. He underwent several lumbar surgeries for spinal stenosis (L4–L5, then L3–L4, and later L5–S1 with fusion to S1), as well as multiple infiltrations and pulsed radiofrequency, without improvement. Neurophysiological and imaging studies showed no significant compression, except for edema at the ischial insertion of the quadratus femoris muscle. A diagnostic local anesthetic infiltration temporarily resolved the pain, confirming ischiofemoral impingement syndrome. He was treated with osteotomy of the lesser trochanter, achieving complete pain resolution and functional recovery. This case highlights the importance of considering extraradicular causes in patients with persistent sciatic pain after spinal surgery.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500737"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Desafíos de la biopsia intraoperatoria: imitador de meningioma del seno cavernoso","authors":"Antonio Pérez Serena ,&nbsp;Daisy Paola Martínez Betancourt","doi":"10.1016/j.neucir.2025.500739","DOIUrl":"10.1016/j.neucir.2025.500739","url":null,"abstract":"<div><div>We report the case of a 56-year-old female patient with controlled human immunodeficiency virus (HIV) who presented with binocular diplopia and a known sixth cranial nerve palsy. Imaging revealed a lesion centered in the right cavernous sinus (CS) causing mass effect and displacement of adjacent structures. Progressive cranial nerve involvement led to surgical intervention. Intraoperative biopsy yielded inconclusive results, with initial suspicion pointing toward meningioma. Definitive diagnosis was only possible after paraffin-embedded histopathology confirmed a CS hemangioma. Postoperative management included pain control and corticosteroid tapering. The patient remains stable under multidisciplinary follow-up. This case underscores the diagnostic challenges of CS lesions and the limitations of intraoperative biopsy in differentiating vascular tumors from meningiomas and other CS neoplasms such as schwannomas should be taken into account.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500739"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calidad de vida posoperatoria temprana en pacientes con glioma: un estudio de cohorte prospectivo","authors":"João Meira Gonçalves ,&nbsp;Jorge Moutinho ,&nbsp;Paulo Linhares ,&nbsp;Bruno Carvalho","doi":"10.1016/j.neucir.2025.500741","DOIUrl":"10.1016/j.neucir.2025.500741","url":null,"abstract":"<div><h3>Background</h3><div>Since gliomas have no cure, the quality of life (QoL) reported by patients assumes utmost importance in the therapeutic strategy. However, few studies have provided longitudinal data about how surgical resection impacts QoL as reported by patients, and even fewer have included preoperative assessments. The aim of this pilot study was to assess how glioma patients’ QoL changes in the early postoperative period of glioma resection, at 1 month and 6 months, compared to preoperative.</div></div><div><h3>Methods</h3><div>Patients undergoing surgical resection of low-grade glioma (LGG) or high-grade glioma (HGG) were prospectively included from January 2022 to December 2022. To analyze patient-reported QoL we used EORTC QLQ-C30 and BN20 questionnaires applied preoperatively and at 1 and 6 months after surgery.</div></div><div><h3>Results</h3><div>We evaluated 34 patients (LGG-9; HGG-25). There were no differences in QoL at all evaluation time points between LGG and HGG groups. Within the LGG patients, QoL scores remained stable throughout 1- and 6-month evaluations. In patients with HGG, when compared to baseline, there were no meaningful variations in QoL at 1 month, but a clinically and statistically significant improvement (p<!--> <!-->=<!--> <!-->0.035) was found at 6 months. Total resection was associated with improved QoL in HGG patients at 6 months (p<!--> <!-->=<!--> <!-->0.025). At individual level, considering a minimum clinically significant value of 10, most HGG patients improved their QoL, while most LGG patients remained stable. Regarding subdomain analysis, a clinically and statistically significant improvement in future uncertainty was found in both LGG (p<!--> <!-->=<!--> <!-->0.042) and HGG (p<!--> <!-->=<!--> <!-->0.024) patients at 6 months.</div></div><div><h3>Conclusions</h3><div>Contrarily to previous studies that revealed a deterioration in HGG patients at 6 months, our preliminary data suggest an improvement in the QoL of these patients at 6 months. Additionally, total resection seems to be beneficial, as it was not associated with QoL deterioration, and can even improve QoL.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 3","pages":"Article 500741"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147827987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiencia preliminar con el exoscopio VITOM® 3D en el tratamiento microquirúrgico de aneurismas cerebrales","authors":"Joel Caballero-García ,&nbsp;Justo Gonzáles Gonzáles ,&nbsp;Guillermo Sánchez Paneque ,&nbsp;Luis Horta Clavero","doi":"10.1016/j.neucir.2025.500729","DOIUrl":"10.1016/j.neucir.2025.500729","url":null,"abstract":"<div><h3>Background and objectives</h3><div>The use of a digital three-dimensional (3D) exoscope system in neurosurgery is increasing as an alternative to the operative microscope due to its similar visual fidelity but superior ergonomics. However, publications on cerebral aneurysms treated with this are scarce.</div></div><div><h3>Methods</h3><div>Clinical information, surgical records and, imaging of patients with cerebral aneurysms undergoing surgery by a single surgeon, from December 2023 to March 2025, using the VITOM 3D as a vision/magnification method exclusively, is analyzed. Postoperative follow-up included angio-CT scan. Descriptive statistics and data relating to operative time and complications were analyzed. An extensive discussion regarding other authors’ experience using 4<!--> <!-->K 3D exoscopes in microsurgical clipping of cerebral aneurysms was performed and compared with the present series.</div></div><div><h3>Results</h3><div>Eighty-eight patients with 107 cerebral aneurysms underwent surgery. Most patients were female (65.9%), with a mean age of 52.6 (±13.6) years. Grades I-III WFNS score was seen in 74 (84.1%) patients, with 14 (15.9%) having grade IV. Ruptured aneurysm rate was 94.3%, but up to 14.9% associated unruptured aneurysms were recorded. Complications rate was 9.1%. A favorable outcome was observed in 83.0% of patients based on modified Rankin Scale score at 30 days.</div></div><div><h3>Conclusion</h3><div>VITOM 3D exoscope is a valid alternative to the surgical microscope, since it offers comparable visualization but superior ergonomics, at a lower cost. Randomized comparative studies with a larger series of cases should be carried out to increase the level of evidence.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 2","pages":"Article 500729"},"PeriodicalIF":0.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147415506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}