Neurocirugia最新文献

{"title":"Petrosectomía retrosigmoidea intradural inframeatal (IIRP): experiencia multicéntrica y revisión anatómica de un abordaje eficaz para la región petroclival","authors":"Pedro Miguel González-Vargas,&nbsp;José Luis Thenier-Villa,&nbsp;Álvaro Martín-Gallego,&nbsp;Pablo Sanromán Álvarez,&nbsp;Antonio Riveiro,&nbsp;Rosa María Martínez Rolán,&nbsp;Juan Pou","doi":"10.1016/j.neucir.2026.500762","DOIUrl":"10.1016/j.neucir.2026.500762","url":null,"abstract":"<div><h3>Introduction</h3><div>Tumorous and infectious lesions of the petrous bone pose a surgical challenge due to their deep location and proximity to critical neurovascular structures. Inframeatal intradural retrosigmoid petrosectomy (IIRP) is an alternative route that allows direct access to the petrous apex with minimal morbidity.</div></div><div><h3>Methods</h3><div>Retrospective study of 11 patients who underwent IIRP between 2015 and 2025 in two hospitals in southern Galicia. Demographic variables, type of lesion, surgical time, degree of resection, complications, and progression-free survival were collected. A descriptive analysis and Kaplan–Meier curve were performed.</div></div><div><h3>Results</h3><div>Eleven patients were included (7 women, 4 men; mean age 48.9 years). Lesions included invasive cholesteatoma (<em>n</em> <!-->=<!--> <!-->4), petroclival meningiomas (<em>n</em> <!-->=<!--> <!-->2), chondrosarcoma (<em>n</em> <!-->=<!--> <!-->1), atypical schwannoma (<em>n</em> <!-->=<!--> <!-->1), squamous cell carcinoma (<em>n</em> <!-->=<!--> <!-->1), breast cancer metastasis (<em>n</em> <!-->=<!--> <!-->1) and an intraosseous abscess due to <em>Actinomyces</em> (<em>n</em> <!-->=<!--> <!-->1). Gross total resection was achieved in 81.8%, with one transient complication (9.1%) and one recurrence. Progression-free survival analysis showed satisfactory recurrence-free survival up to 20 months.</div></div><div><h3>Conclusion</h3><div>IIRP is a safe, effective, and versatile technique for approaching select lesions of the petrous bone. It allows sufficient exposure with low morbidity and is also useful in refractory infectious cases.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 4","pages":"Article 500762"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148545126","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":"Atraer a los mejores: un reto para el futuro de la neurocirugía en nuestro país","authors":"Ramiro D. Lobato,&nbsp;Alfonso Lagares,&nbsp;Jose Antonio Fernández-Alén","doi":"10.1016/j.neucir.2026.500761","DOIUrl":"10.1016/j.neucir.2026.500761","url":null,"abstract":"","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 4","pages":"Article 500761"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148545127","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":"Aparición de neumoencéfalo posoperatorio en cirugía de fosa posterior en posición semisentada: prevalencia, factores y patrones","authors":"Liezel Ulloque-Caamaño,&nbsp;Mario Gomar-Alba,&nbsp;Benjamin Romero-Leguina,&nbsp;Nadin J. Abdala-Vargas,&nbsp;Juan F. Villalonga,&nbsp;Álvaro Campero","doi":"10.1016/j.neucir.2026.500763","DOIUrl":"10.1016/j.neucir.2026.500763","url":null,"abstract":"<div><h3>Background</h3><div>Posterior fossa (PF) surgery in the semi-sitting position (SSP) offers benefits for the patient, the anesthesiologist and the surgeon. However, in neurosurgery, neuroanesthesiology and related fields, a certain paradigm has been established regarding the potential high risk of this position, including the possibility of developing postoperative pneumoencephalus (PPN). The objective of the present work is to assess the prevalence, factors, and patterns related with PPN in SSP in a heterogeneous group of patients with PF conditions.</div></div><div><h3>Methods</h3><div>Observational, descriptive, cross-sectional study with prospective data collection. Was conducted in two institutions. January 2020 and June 2023. 192 patients with intradural PF pathology operated on in the SSP were included.</div></div><div><h3>Results</h3><div>In most patients (93.2%; <em>n</em>:179) PPN was observed on postoperative CT. The most frequent pattern of PPN was subdural. No patient (0%; <em>n</em>:0) developed tension PPN, so none required surgery. A significant association was found between subdural PPN and operating time. We found a higher presence of PPN in patients with an age range of 40–60 years and in the group of patients<!--> <!-->&gt;<!--> <!-->60 years.</div></div><div><h3>Conclusions</h3><div>The majority of patients in our series presented PPN. The most frequent pattern was subdural. There was an association between operating time and subdural PPN. There was an association between the older patient groups and PPN. No patient presented tension PPN.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 4","pages":"Article 500763"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148545132","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":"Formación neuroquirúrgica en África. Parte 2: desafíos y soluciones para un acceso equitativo a la neurocirugía","authors":"Ruben Rodríguez-Mena,&nbsp;José Piquer-Martínez,&nbsp;Maria Jose García-Rubio,&nbsp;José Luis Llácer-Ortega,&nbsp;Mubashir Qureshi Mahmood,&nbsp;Jose Piquer-Belloch","doi":"10.1016/j.neucir.2026.500754","DOIUrl":"10.1016/j.neucir.2026.500754","url":null,"abstract":"<div><h3>Background and objective</h3><div>Equitable access to neurosurgery remains a critical challenge in East Africa, due to the shortage of specialists and the lack of structured training programs. In this second part, the “Equip, Treat, and Educate” (ETE) model, developed by the NED Foundation, is analyzed to promote sustainable neurosurgical training in resource-limited settings, in collaboration with COSECSA. A series of innovative initiatives with educational and social impact are also presented.</div></div><div><h3>Materials and methods</h3><div>A retrospective review of the NED Foundation's activities between 2008 and 2024 was conducted, with special emphasis on actions carried out at the NED Institute in Zanzibar. The analysis included clinical data, training programs, institutional cooperation, and outcomes associated with the ETE model, which is structured into three levels of increasing complexity.</div></div><div><h3>Results</h3><div>During the analyzed period, the NED Institute attended to more than 30,000 patients and performed 2,537 free surgeries, with hydrocephalus being the most frequently treated condition. In parallel, more than 30 medical and nursing training courses were organized. In addition, thirteen key educational initiatives are proposed to strengthen local capacities, including practical workshops, surgical simulations, mentorship, rotational placements, international exchanges, scholarships, online training, and the development of open resources. These actions can enhance training quality, promote talent retention, and strengthen professional networks in the region.</div></div><div><h3>Conclusions</h3><div>The ETE model, in conjunction with the educational initiatives promoted by the NED Foundation and COSECSA, constitutes an effective and replicable strategy for strengthening neurosurgical training in low-income countries. This approach drives local professional development and enables progress toward more accessible, equitable, and sustainable neurosurgery.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 4","pages":"Article 500754"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148545131","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":"Hiponatremia en la hemorragia subaracnoidea aneurismática: revisión sistemática y metaanálisis sobre enfoques de manejo","authors":"Mahdi Mehmandoost,&nbsp;Amirmohammed Bahri,&nbsp;Diba Akbarzadeh,&nbsp;Amirmohammed Tohidnia,&nbsp;Hamidreza Hassanzadeh,&nbsp;Muhammad Paras Pashazadeh,&nbsp;Mohammadreza Moshref,&nbsp;Morteza Sheikhi Nooshabadi,&nbsp;Sayeh Oveisi,&nbsp;Mohammadamin Sabbagh Alvani,&nbsp;Alireza Zali,&nbsp;Saeed Oraee-Yazdani,&nbsp;Farzan Fahim","doi":"10.1016/j.neucir.2026.500775","DOIUrl":"10.1016/j.neucir.2026.500775","url":null,"abstract":"<div><div>Hyponatremia complicates between 32% and 48.9% of aneurysmal subarachnoid hemorrhage (SAH) cases, doubling the risk of cerebral ischemia (24% vs. 12%; p<!--> <!-->=<!--> <!-->0.045) and increasing mortality 2.7-fold. However, only 28% of hospitals use standardized protocols, that it highlights the need for evidence-based management. This PRISMA-compliant systematic review and meta-analysis included 21 studies (1749 patients; 1984–2025) from PubMed, EMBASE, and Scopus. The secondary variables analyzed included sodium correction, protocol adherence, delayed cerebral ischemia (DCI) and ICU length of stay. Three main findings were identified: albumin–fludrocortisone synergy: early combination (&lt;72<!--> <!-->h post-SAH) of albumin (60<!--> <!-->g/day) and fludrocortisone reduced hyponatremia by 45% (49.2% to 27.0%) and DCI by 29% (adjusted RR<!--> <!-->=<!--> <!-->0.63). This approach yielded an NNT of 4.3 compared to 13 for clot retrieval. Time-Phased Protocol: Phase I (days 1–3): Albumin<!--> <!-->+<!--> <!-->fludrocortisone decreased symptomatic vasospasm by 67% (p<!--> <!-->=<!--> <!-->0.02). Phase II (days 4–7): tolvaptan 15<!--> <!-->mg/day shortened ICU stay by 3.2 days (p<!--> <!-->=<!--> <!-->0.01) and improved 6-month mRS scores by 41.7% (p<!--> <!-->=<!--> <!-->0.045). Impact of center volume: high-volume centers (&gt;50 SAH cases/year) had 2.1 times higher protocol adherence (89% vs. 23%) and 35% fewer reoperations. The meta-analysis confirmed a significant reduction in symptomatic vasospasm (pooled OR<!--> <!-->=<!--> <!-->0.40; 95% CI: 0.18–0.90; p<!--> <!-->=<!--> <!-->0.026) and a higher likelihood of hyponatremia correction (OR<!--> <!-->=<!--> <!-->3.37; 95% CI: 1.57–7.27; p<!--> <!-->=<!--> <!-->0.002) in groups receiving active protocols (e.g., albumin/fludrocortisone, tolvaptan) compared to standard care or historical controls. Fluid restriction was associated with higher mortality and is discouraged. A bimodal protocol combining early albumin and fludrocortisone followed by later tolvaptan can lead to better clinical outcomes. Greater institutional experience and real-time sodium monitoring are recommended. Phase III trials comparing saline-based strategies vs. albumin-based are needed.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 4","pages":"Article 500775"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148545446","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":"Fijación del colgajo con dispositivo tipo remache o con placas y tornillos de titanio: un análisis de minimización de costes","authors":"Álvaro Gómez de la Riva,&nbsp;Fernando Muñoz-Hernández","doi":"10.1016/j.neucir.2026.500764","DOIUrl":"10.1016/j.neucir.2026.500764","url":null,"abstract":"<div><h3>Objectives</h3><div>Clamp-like devices such as Cranial LOOP have similar performance and safety than titanium plates and screws to fix the bone flap after a craniotomy. This raises the question of which of these methods is more cost-effective. This cost-minimization analysis compares the cost associated with each of these methods in the setting of an already published RCT.</div></div><div><h3>Material and Methods</h3><div>The data from a previously published RCT was analyzed to assess the mean cost of bone flap fixation after craniotomy using Cranial LOOP or plates and screws; this analysis included the cost of the devices, the implantation time cost and the implantation instruments reprocessing cost. This data was then analyzed to model the global cost of the craniotomy fixation for a range of implant unitary costs.</div></div><div><h3>Results</h3><div>As a median, craniotomies were fixed with 3 Cranial LOOP or with 4 sets of titanium plates and screws. Both the total and the unitary cost for the devices were significantly lower with Cranial LOOP than with plating systems (306.4<!--> <!-->±<!--> <!-->100.0 € vs. 568.8<!--> <!-->±<!--> <!-->261.6 €, p&lt;<!--> <!-->0.001; 88.2<!--> <!-->±<!--> <!-->7.3 € vs. 154.9<!--> <!-->±<!--> <!-->67.6 €, p&lt;<!--> <!-->0.001). The implantation time of Cranial LOOP was significantly shorter than that of plating systems (1.70<!--> <!-->±<!--> <!-->0.20<!--> <!-->minutes vs. 6.27<!--> <!-->±<!--> <!-->1.88<!--> <!-->minutes, p&lt;<!--> <!-->0.001). Cranial LOOP does not require implantation instruments, while the implantation <em>kits</em> for plating systems require reprocessing (washing and sterilization). In total, the craniotomy fixation with Cranial LOOP costs between 360.56 € and 370.77 € less than with plating systems.</div></div><div><h3>Conclusions</h3><div>The cost of craniotomy fixation with Cranial LOOP was half the cost of fixation with plating systems. In addition, not requiring instrument reprocessing for Cranial LOOP saved water and energy.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 4","pages":"Article 500764"},"PeriodicalIF":0.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148545445","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":"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":"O-22 - FRAGILIDAD Y PRONÓSTICO TRAS CIRUGÍA POR METÁSTASIS VERTEBRALES: COMPARACIÓN DE MSTFI Y MFI-5 EN PRÁCTICA CLÍNICA REAL","authors":"P. Pérez Orán,&nbsp;H. Roldán Delgado,&nbsp;M. Martín Zamora,&nbsp;J. Ortega Van Oostrom,&nbsp;C. Pardo Fernández,&nbsp;L. Brage Martín,&nbsp;M. García Conde,&nbsp;P. Febles García","doi":"10.1016/S1130-1473(26)00096-5","DOIUrl":"10.1016/S1130-1473(26)00096-5","url":null,"abstract":"","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 ","pages":"Article 115115"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148230589","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":"O-11 - DESCOMPRESIÓN MICROVASCULAR EN EL ESPASMO HEMIFACIAL: RESULTADOS CLÍNICOS Y VALOR DE LA NEUROMONITORIZACIÓN INTRAOPERATORIA. EXPERIENCIA EN NUESTRO CENTRO","authors":"G. Martín Quintero,&nbsp;A. Torres Díaz,&nbsp;J.L. Sanmillán Blasco,&nbsp;I. Fernández Conejero,&nbsp;A. Blanco Ibáñez de Opacua,&nbsp;M. Císcar Fabuel","doi":"10.1016/S1130-1473(26)00042-4","DOIUrl":"10.1016/S1130-1473(26)00042-4","url":null,"abstract":"","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 ","pages":"Article 115061"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148235629","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":"V-09 - FÍSTULA DE STERNBERG. ABORDAJE ENDONASAL AL RECESO LATERAL ESFENOIDAL, ANATOMÍA Y TÉCNICA QUIRÚGICA","authors":"B. Valdés Valdés,&nbsp;A. Llansana Ríos,&nbsp;G. Tresserres Gine,&nbsp;C.F. Alarcón Alba,&nbsp;C. Toledano Alcalde,&nbsp;L. Pujals Pon,&nbsp;M. Buxeda Rodríguez,&nbsp;M. Romero Rosich,&nbsp;M.D. Sánchez Casas,&nbsp;J.F. López Lozano,&nbsp;R. Fuentes Rico,&nbsp;J.J. Sanz González","doi":"10.1016/S1130-1473(26)00065-5","DOIUrl":"10.1016/S1130-1473(26)00065-5","url":null,"abstract":"","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 ","pages":"Article 115084"},"PeriodicalIF":0.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148235691","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}