Neurocirugia最新文献

{"title":"Meningocele intraabdominal gigante en una paciente con síndrome de Marfan: descripción de un caso y manejo quirúrgico","authors":"Jorge Cabrera-Montes,&nbsp;Ricardo Díez-Valle","doi":"10.1016/j.neucir.2025.500713","DOIUrl":"10.1016/j.neucir.2025.500713","url":null,"abstract":"<div><div>Anterior sacral meningocele is a rare complication associated with Marfan syndrome. There is no consensus regarding management and surgical treatment. Here, we describe the case of a 44-year-old women with Marfan syndrome who presented a progressive abdominal mass with gastrointestinal and urinary symptoms. Abdominopelvic MRI revealed a 3<!--> <!-->cm S1 dural ectasia and a 19<!--> <!-->×<!--> <!-->17<!--> <!-->×<!--> <!-->15<!--> <!-->cm abdominal mass. A posterior sacral transdural approach was performed. Dural friability made ligation unfeasible. Obliteration with a fat flap and fibrin sealant was the treatment alternative. Postoperative MRI imaging performed 4<!--> <!-->months after surgery evidenced complete resolution of the intrabdominal collection. The patient remains free of symptoms 2<!--> <!-->years later. Here we present one of the largest meningoceles reported to date in the literature, and illustrate the surgical management in a patient with Marfan syndrome, where technical difficulties arose. Solely posterior sacral transdural approach with fat graft may be sufficient for the treatment of these patients even with voluminous pelvic meningoceles.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500713"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908672","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":"Epileptogenicidad después de estereoelectroencefalografía y monitorización invasiva de rejillas subdurales: un análisis retrospectivo de pacientes adultos y pediátricos con epilepsia refractaria","authors":"Sonia Pulido ,&nbsp;Sven Ivankovic ,&nbsp;Nolan Winslow ,&nbsp;Andrés Maldonado","doi":"10.1016/j.neucir.2025.500703","DOIUrl":"10.1016/j.neucir.2025.500703","url":null,"abstract":"<div><h3>Objective</h3><div>To assess if removal of stereoelectroencephalography (SEEG) or subdural grids (SDG) is associated with an increased seizure frequency in patients with refractory epilepsy during the immediate postoperative period.</div></div><div><h3>Methods</h3><div>37 patients with refractory epilepsy that underwent monitoring with SEEG or SDG during November 2012-March 2022 were identified using electronic medical records from asingle institution. Seizure history, duration of intracranial monitoring, and monitored brain regions were recorded.</div></div><div><h3>Results</h3><div>5.0% and 5.9% of SEEG and SDG patients had a seizure within 48 h post-termination of monitoring. 25% and 11.8% of SEEG and SDG patients had a seizure between 48 h and 1-week after surgery. Between 1 week and 1 month after SEEG or SDG removal, 35% and 41.2% of patients had a seizure. 30% and 50% SEEG or SDG patients had a seizure between 1- and 2-months following removal. Overall change in postoperative seizure frequency was not significant. Seizure frequency increased for 11.8% of SDG patients while frequency remained unchanged for 5.9% and decreased for 82.4%. No patients post-SEEG removal in our cohort experienced an increased seizure frequency. 95% experienced a decrease in seizure frequency and no change was observed in 5%.</div></div><div><h3>Conclusion</h3><div>SEEG is not associated with increased epileptogenicity after termination of monitoring. Two patients post-SDG removal experienced an increase in seizure frequency. While patients with refractory epilepsy may continue to have seizures during the immediate postoperative period, it is likely that patients will experience a decrease in seizure frequency after removal of SEEG or SDG.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500703"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908673","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":"Visión endoscópica 360° de la órbita: estudio anatómico comparativo de los abordajes endonasal y transorbital","authors":"D. Gagliano ,&nbsp;R. Manfrellotti ,&nbsp;N. Lasunin ,&nbsp;A. Prats-Galino ,&nbsp;A. Di Somma ,&nbsp;J. Enseñat","doi":"10.1016/j.neucir.2025.500704","DOIUrl":"10.1016/j.neucir.2025.500704","url":null,"abstract":"<div><h3>Background and objective</h3><div>Treatment of lesions located within and surrounding the orbit pose considerable surgical challenges, due to the presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely used to deal with orbital pathologies. However, in recent decades we have witnessed the emergence of minimally invasive techniques to reduce morbidity and hospitalization times. Among these techniques are the endoscopic endonasal approach (EEA) and the subsequently developed endoscopic transorbital approach (ETOA). This anatomical study aims to compare and combine the surgical view offered by these 2<!--> <!-->endoscopic pathways to achieve a circumferential access to the orbit.</div></div><div><h3>Methods</h3><div>Anatomic dissections were performed at the Laboratory of Surgical Neuroanatomy (LSNA) of the Human Anatomy and Embryology Unit, University of Barcelona (Barcelona, Spain) on 5 cadaveric specimens (10 sides), whose arterial and venous systems were injected with red and blue latex respectively. Dissections were made with microsurgical instruments and a surgical endoscope.</div></div><div><h3>Results</h3><div>After careful removal of the intraorbital fat, all the extraocular muscles were exposed and dissected, as well as the optic nerve, the ophthalmic artery, and the lacrimal gland. Special emphasis was given to dissecting the nerves’ course from the cavernous sinus to their muscle innervation: Oculomotor and its branches, trochlear, abducent and ophthalmic nerve with its branches (frontal, nasociliary and lacrimal nerve). Each of the 2<!--> <!-->endoscopic pathways provided a different perspective of the orbit and its structures. After both corridors were completed, a communication between the surgical pathways was highlighted, in a so-called connection area.</div></div><div><h3>Conclusions</h3><div>The combination of the EEA and ETOA provides a 360° view of the orbit and its contents. The EEA offers an inferior and medial view of the orbit, through the lamina papyracea of the ethmoid in the first case and through the roof of the maxillary sinus in the latter. At the same time, the ETOA shows a lateral perspective, removing the lateral rim of the orbit, allowing great maneuverability inside the orbit and a wide visualization. This study provides a detailed overview of the surgical neuroanatomy of the orbit, which is an essential and didactic baseline in preparation for practical clinical applications. Overall, EEA and ETOA seem adequate to gain optimal exposure of the orbit and can be adapted to treat a wide range of pathologies. Yet, surgical case series are necessary to establish the true clinical value of these endoscopic approaches in orbital and peri-orbital surgery. However, the limited number of specimens analyzed (5 cadavers, 10 sides) must be acknowledged as a limitation.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500704"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908892","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":"Fístula quilosa durante microdiscectomía cervical anterior: presentación de caso clínico y revisión de la literatura","authors":"Pelayo Hevia-Rodríguez,&nbsp;Laura Panés Laglera,&nbsp;Irati de Goñi García,&nbsp;Fernando Iturbe-Sarmiento,&nbsp;Nicolás Samprón","doi":"10.1016/j.neucir.2025.500736","DOIUrl":"10.1016/j.neucir.2025.500736","url":null,"abstract":"<div><div>The anterior approach to the cervical spine is a widely used technique in spinal surgery. Although its most common complications involve vascular, neural, or digestive structures, there is also the potential for injury to lymphatic vessels, which can lead to serious complications if not promptly diagnosed and treated. We present the case of a 70-year-old woman with a history of lumbar arthrodesis and a C5-C6 cervical prosthesis, who underwent an anterior microdiscectomy at C7-T1 via a right-sided approach. During dissection, a dense whitish fluid compatible with chyle was observed, indicating injury to a lymphatic vessel. Ligation with suture was performed and a prevertebral drain was placed. In the postoperative period, the patient developed a mild hematoma in the acromioclavicular region, without cervical collections. The drain was removed after four days of total fasting, followed by the introduction of a low-fat diet. The patient was discharged without complications. After five years of follow-up, no associated complications have been observed. Chyle fistula following anterior cervical discectomy is a rare complication (0.02%) and should be suspected in the presence of milky fluid in the surgical wound, drainage, and/or progressive accumulation. Early diagnosis and appropriate treatment are essential to prevent more severe outcomes. The risk is higher in left-sided approaches near C6 and low right-sided approaches (C7-T1), particularly in the presence of anatomical variants.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500736"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908890","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 1: Habilidades esenciales y desafíos estructurales para la equidad","authors":"María J. García-Rubio ,&nbsp;Jose Piquer-Martínez ,&nbsp;Jose Piquer-Belloch ,&nbsp;Ruben Rodríguez-Mena","doi":"10.1016/j.neucir.2025.500702","DOIUrl":"10.1016/j.neucir.2025.500702","url":null,"abstract":"<div><div>Neurosurgery requires rigorous training, yet access remains limited in low-resource countries, particularly in Africa, creating a crisis in specialized care.</div><div>This paper, grounded in the principles of global neurosurgery, examines the essential competencies required in neurosurgical training, distinguishing between clinical skills—such as technical proficiency and decision-making—and non-clinical skills, including leadership, emotional management, and communication. Deliberate practice is emphasized as a key methodology for improving skill acquisition through structured repetition, continuous feedback, and expert supervision.</div><div>Additionally, the main challenges of specialization in East Africa are analyzed: inadequate infrastructure, overburdened health systems, limited and heterogeneous residency programs, and a shortage of qualified mentors. Finally, the development of innovative educational strategies is proposed to enhance training in resource-constrained settings and contribute to the sustainable advancement of the specialty.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500702"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908666","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":"Percepción del paciente y cambio clínicamente significativo tras laminectomía cervical simple en la mielopatía cervical degenerativa: estudio de cohorte prospectivo","authors":"Antonio Montalvo-Afonso ,&nbsp;Vicente Martín-Velasco ,&nbsp;Javier Martín-Alonso ,&nbsp;Rubén Diana-Martín ,&nbsp;Jerónimo González-Bernal ,&nbsp;Pedro David Delgado-López","doi":"10.1016/j.neucir.2025.500735","DOIUrl":"10.1016/j.neucir.2025.500735","url":null,"abstract":"<div><h3>Introduction</h3><div>Validated clinical scales for cervical myelopathy (CM) assess disease severity and treatment efficacy, but often fail to capture the patient's subjective perception of treatment effects. This study aimed to correlate commonly used clinical scales for CM with patient-perceived outcomes after surgical treatment. Additionally, it sought to establish minimum clinically important difference (MCID) thresholds for scales strongly correlating with patient perception.</div></div><div><h3>Patients and methods</h3><div>A prospective, single-center observational study followed 47 patients with degenerative CM who underwent simple cervical laminectomy for one year. Patients were assessed using the mJOA, Nurick, cervical and brachial Visual Analogue Scales (VAS), the Neck Disability Index (IDC), and the EuroQol-5D (EQ5D). Patient perception of global effect (PGE) was assessed at 6 months and 1 year post-surgery using an anchor question asking if they perceived improvement, worsening, or no change. MCID was calculated using three anchor-based methods: mean difference, change difference, and the Youden index from Receiver Operating Characteristic (COR) curves. Definitive MCID thresholds were the average of these three methods.</div></div><div><h3>Results</h3><div>At the end of the follow-up, 25 patients (53.2%) had perceived clinical improvement with surgery, 15 (31.9%) had perceived no changes, and 7 (14.9%) had perceived worsening. The scales that showed the best correlation with patient perception were mJOA (η2<!--> <!-->=<!--> <!-->0.25; p<!--> <!-->=<!--> <!-->0.002), Nurick (η2<!--> <!-->=<!--> <!-->0.19; p<!--> <!-->=<!--> <!-->0.009), and NDI (η2<!--> <!-->=<!--> <!-->0.17; p<!--> <!-->=<!--> <!-->0.016). The definitive MCID thresholds for improvement were an increase in score ≥ 1.5 points in mJOA, a reduction of ≥0.56 points in the Nurick scale, and a reduction of ≥5 points in NDI. The definitive MCID thresholds for worsening were an increase of ≤ 0.23 points or a loss of score in mJOA, an increase of ≥ 0.33 points in the Nurick scale, and an increase of ≥1.26 points in NDI. According to the MCID thresholds, the majority of patients achieved clinically significant improvement: 59.6% in mJOA (compared to 25.5% with worsening), 27.7% in the Nurick scale (compared to 6.4% who worsened), and 42.5% in the NDI (versus 19.1% who worsened).</div></div><div><h3>Conclusion</h3><div>Patient perception of outcome following cervical laminectomy for spondylotic cervical myelopathy significantly correlates with functional scales like mJOA, Nurick, and NDI. The MCID thresholds indicate that patients require a more substantial change to perceive improvement than worsening, highlighting an asymmetry in subjective perception of treatment effects. These findings support using MCID, anchored in subjective perceptions, as a complementary tool to interpret the clinical relevance of quantitative changes in clinical scales.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500735"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908894","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":"Medidas de prevención de infecciones quirúrgicas en neurocirugía: encuesta y análisis comparativo","authors":"Cristina Sánchez-Viguera ,&nbsp;Josep M. Badia","doi":"10.1016/j.neucir.2025.500678","DOIUrl":"10.1016/j.neucir.2025.500678","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical site infections (SSI) are among the most common type of healthcare–associated infections and are involved with an increase in morbidity, mortality and higher healthcare costs.</div></div><div><h3>Methods</h3><div>The Observatory of Infection in Surgery has conducted a survey to assess the level of awareness and implementation of the preventive measures for SSI. A 64-question questionnaire was given to SENEC (Sociedad Española de Neurocirugía) members.</div></div><div><h3>Results</h3><div>The survey was answered by 123 neurosurgeons. There is a gap between clinical guidelines and neurosurgery practice (67%), even though neurosurgeons place a high value on international (81.7%) or national (78.7%) clinical guidelines. There are still practices not supported by scientific evidence that some of our respondents follow, including antibiotic prophylaxis ≥ 24<!--> <!-->h (10.6%), the habit of not allowing the antiseptic solution to air dry (38.2%) or the use of transparent plastic adhesive drape on the surgical field (77.4%). The most widespread practice for hair management is the selective removal from the surgical area (83.3%). It is most commonly performed by the neurosurgeon himself, in the operating room, which is a significant difference from the use of other surgical specialties (68.5% vs 3.5%, <em>P</em>&lt;.001). There are only 37% of respondents who use alcohol solutions. Double-gloving is utilized by 16.7% of neurosurgeons. The usual use of drainage is quite widespread (60.7%), while the rate of nutritional assessment prior to major surgery is very low (7.5%). Only 37.2% report providing feedback on SSI rates to surgical teams, and a small 16.5% have received specific training programs on SSI.</div></div><div><h3>Conclusion</h3><div>Scientific evidence-supported measures are not fully incorporated into neurosurgical practice, and there is a lack of specific training in surgical infection prevention. Additionally, a specific issue has been identified, particularly regarding hair management. Neurosurgeons should actively participate in SSI prevention programs and analyse the reasons why they do not implement certain strategies into their clinical practice.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500678"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908671","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":"Impacto de las malformaciones arteriovenosas en los giros precentral y poscentral sobre los volúmenes intracraneales","authors":"Abdulkerim Gokoglu ,&nbsp;Hüseyin Yiğit ,&nbsp;Tolga Turan Dündar ,&nbsp;Erdoğan Unur ,&nbsp;Ahmet Selçuklu","doi":"10.1016/j.neucir.2025.500705","DOIUrl":"10.1016/j.neucir.2025.500705","url":null,"abstract":"<div><h3>Objective</h3><div>Arteriovenous malformations are known as arterial-venous shunts that connect nidus, the nourishing arteries, to draining veins. Although they are not very common in the brain, they are responsible for approximately 2% of all strokes. The volumetric changes in the surrounding brain tissues caused by cerebral arteriovenous malformations have not yet been reported.</div></div><div><h3>Methods</h3><div>To detect these volumetric changes, MR data were acquired from 38 controls and 25 unoperated patients with arteriovenous malformations in the precentral and postcentral gyrus. MR data were analyzed with vol2Brain, Ceres and HIPS pipelines. The niduses of these patients were resected by transsulcal microsurgical dissection.</div></div><div><h3>Results</h3><div>A comprehensive volumetric analysis encompassing 135 distinct brain, cerebellar, and hippocampal structures was conducted using the Vol2brain software. Comparison between the patient group and the control group revealed significant volumetric differences. Specifically, the patient group exhibited significantly larger volumes in the nucleus accumbens, fusiform gyrus, middle occipital gyrus, anterior insula, inferior lateral ventricle, and the gray matter of cerebellar lobules VIIIA and VIIIB compared with the control group. Conversely, relative to the control group, the patient group demonstrated significantly smaller volumes in the gray matter of cerebellar lobules IV, I-II, and III, as well as in the hippocampal subfields of CA2-CA3, SR-SL-SM, and the subiculum.</div></div><div><h3>Conclusion</h3><div>Arteriovenous malformations occurring in the precentral and postcentral gyrus lead to volumetric changes in structures distant from the site of the malformation, including the brain, hippocampus, and even the cerebellum. Therefore, arteriovenous malformations may influence the volumes of structures located not only within their immediate brain region but also in other parts of the cerebrum and cerebellum. Understanding these volumetric changes can aid in explaining patient symptoms. However, further research is required regarding whether these volumetric changes result from the mass effect of the nidus or stem from another underlying cause.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"37 1","pages":"Article 500705"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145908893","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 uso del electrocauterio monopolar en la cirugía de revisión de estimuladores del nervio vago es un riesgo que hay que evitar o una opción quirúrgica segura?","authors":"Cezmi Çağrı Türk ,&nbsp;Umut Ogün Mutlucan ,&nbsp;Orhan Günay ,&nbsp;Fatma Genç ,&nbsp;Meltem Korucuk ,&nbsp;Gültekin Kutluk","doi":"10.1016/j.neucir.2025.500674","DOIUrl":"10.1016/j.neucir.2025.500674","url":null,"abstract":"<div><h3>Background</h3><div>The use of monopolar electrocautery in vagal nerve stimulator (∂VNS) revision surgeries has been debated due to concerns about device interference. Thus, herein, we aimed to evaluate the safety and efficacy of monopolar electrocautery during VNS generator replacement surgeries, particularly its impact on seizure control and battery performance.</div></div><div><h3>Methods</h3><div>A retrospective observational study was conducted on 30 patients who underwent VNS generator revision at a tertiary care center. Patients were divided into 2<!--> <!-->groups: those in whom monopolar electrocautery was used (<em>n</em> = 18) and those in whom it was not used (<em>n</em> = 12). Pre- and postoperative data were collected, including seizure frequency, VNS settings, and operative time. The McHugh Outcome Classification was used to assess seizure control.</div></div><div><h3>Results</h3><div>The surgeries were significantly shorter in the electrocautery group than in the nonelectrocautery group (20.06 ± 2.29 vs. 51.83 ± 12.76<!--> <!-->min, <em>P</em> &lt; 0.001). Furthermore, there was no significant difference in seizure control between the 2<!--> <!-->groups (<em>P</em> &gt; 0.05). In 2<!--> <!-->patients, a decline in seizure control classification was noted. However, this did not reach statistical significance. No lead damage or major complications developed in either group.</div></div><div><h3>Conclusion</h3><div>Monopolar electrocautery significantly reduces the operative time during VNS generator revisions without compromising seizure control or increasing the risk of complications. Thus, monopolar electrocautery can be safely used in VNS revision surgeries, potentially streamlining the procedure and improving patient outcomes. However, further studies with larger populations are needed to confirm these findings.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 6","pages":"Article 500674"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425650","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":"Histiocitosis de células de Langerhans con invasión al parénquima cerebral: una entidad rara","authors":"Claudio Sebastián Iglesias Vargas ,&nbsp;Tomas Quinzacara Aravena ,&nbsp;Ingrid Trujillo Ramos ,&nbsp;Sebastián Vigueras Alvares","doi":"10.1016/j.neucir.2025.500676","DOIUrl":"10.1016/j.neucir.2025.500676","url":null,"abstract":"<div><div>This case presents an unusual case of Langerhans cell histiocytosis with invasion into the brain parenchyma, a rare phenomenon documented in few cases worldwide. The relevance of this case lies in the contribution to the knowledge of this pathology in the pediatric neuro-oncologic context.</div><div>An 11-year-old boy presented with increased volume in the left frontal region, without neurological deficit or systemic symptoms. CT and MRI revealed an aggressive osteolytic lesion with perilesional edema and intracranial extension.</div><div>Complete excision of the lesion was performed, confirming Langerhans cell histiocytosis by immunohistochemistry. Chemotherapy was started with good tolerance and no complications so far.</div><div>This case highlights the need for timely diagnosis and treatment in cases of Langerhans cell histiocytosis with brain involvement, given its potential impact on prognosis and the scarcity of specific guidelines for this type of manifestations.</div></div>","PeriodicalId":51145,"journal":{"name":"Neurocirugia","volume":"36 6","pages":"Article 500676"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145425472","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}