Brain & spine最新文献

{"title":"Preoperative functional connectivity and postoperative neuropathic pain in degenerative cervical myelopathy: An exploratory postoperative follow-up study using resting-state functional MRI.","authors":"Takane Nakagawa, Fumihiko Eto, Tomoyuki Asada, Kento Inomata, Yosuke Ogata, Kotaro Sakashita, Takahiro Sunami, Tomoaki Shimizu, Shun Okuwaki, Hisanori Gamada, Kousei Miura, Hiroshi Noguchi, Toru Funayama, Masao Koda, Masashi Yamazaki, Hiroshi Takahashi","doi":"10.1016/j.bas.2026.106661","DOIUrl":"10.1016/j.bas.2026.106661","url":null,"abstract":"<p><strong>Introduction: </strong>Neuropathic pain (NP) may persist after decompression surgery for degenerative cervical myelopathy (DCM). Although clinical factors associated with postoperative NP have been reported, neuroimaging correlates based on functional connectivity (FC) remain poorly understood.</p><p><strong>Research question: </strong>Are specific preoperative resting-state FC patterns associated with postoperative NP status in patients with DCM?</p><p><strong>Material and methods: </strong>In this retrospective observational study using prospectively collected data, we analyzed 34 patients who underwent cervical decompression surgery for DCM between 2020 and 2024. NP was assessed using the Spine painDETECT Questionnaire (SPDQ) preoperatively and 6 months postoperatively. Patients were classified into NP improvement group (n = 7) and non-improvement group (n = 27). Preoperative resting-state functional MRI data underwent whole-brain ROI-to-ROI FC analysis using the CONN toolbox. Between-group FC differences, correlations with patient-reported outcomes, and factors associated with postoperative SPDQ scores were evaluated.</p><p><strong>Results: </strong>Two preoperative FC networks showed significant between-group differences. FC1, between the right middle frontal gyrus and right thalamus, was higher in the NP improvement group (p-FDR = 0.034), whereas FC2, between the left temporal fusiform cortex and left occipital fusiform gyrus, was higher in the NP non-improvement group (p-FDR = 0.024). FC2 showed moderate correlations with changes in pain intensity, quality of life, and upper-limb function. Multivariable analysis identified FC1 as independently associated with postoperative SPDQ scores (β = -24.05, p = 0.001).</p><p><strong>Discussion and conclusion: </strong>Distinct preoperative FC patterns were associated with postoperative NP status. Preoperative FC may provide exploratory neuroimaging correlates of postoperative NP, although further validation is warranted.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106661"},"PeriodicalIF":2.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13553560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short communication: Fluorescence preservation of protoporphyrin IX in fresh frozen glioma tissue.","authors":"Matthias Demetz, Kevin Buckley, Alexander Miller-Michlits, Yelyzaveta Miller-Michlits, Aleksandrs Krigers, Johannes Kerschbaumer, Claudius Thomé, Adelheid Wöhrer, Christian F Freyschlag","doi":"10.1016/j.bas.2026.106665","DOIUrl":"10.1016/j.bas.2026.106665","url":null,"abstract":"<p><strong>Introduction: </strong>5-ALA-guided fluorescence surgery is widely used in glioma surgery to improve tumor visualization and extent of resection. However, it remains unknown whether Protoporphyrin IX (PpIX) fluorescence persists in fresh frozen tumor tissue and can be reliably detected after thawing.</p><p><strong>Research question: </strong>This study investigates whether PpIX fluorescence remains detectable in fresh frozen glioma tissue and compares the sensitivity of conventional surgical microscopy with a spectroscopic detection method.</p><p><strong>Material and methods: </strong>In this prospective study, 5-ALA-positive and -negative glioma tissue samples were collected intraoperatively, snap-frozen, and stored in a biobank. After thawing, samples were analyzed using both a conventional surgical microscope and a novel spectroscopic prototype. Histopathological confirmation was performed using H&E staining. Fluorescence detection rates were compared between methods.</p><p><strong>Results: </strong>A total of 46 samples were analyzed. Conventional microscopy failed to detect fluorescence in all thawed samples. In contrast, spectroscopic analysis identified PpIX fluorescence in all previously 5-ALA-positive samples, while negative controls showed no signal. Fluorescence detectability was independent of storage duration (5-14 months). These findings indicate that PpIX remains stable in frozen tissue.</p><p><strong>Discussion and conclusion: </strong>PpIX fluorescence persists in fresh frozen glioma tissue and can be reliably detected using sensitive spectroscopic techniques, whereas conventional microscopy is insufficient post-thaw. These results validate the use of biobanked 5-ALA-positive samples for downstream molecular analyses and highlight the importance of advanced detection methods for studying subvisual fluorescence.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106665"},"PeriodicalIF":2.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13570307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148957391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal leptomeningeal disease in patients with solid tumors: A single-center study on clinical presentation, diagnosis, treatment, and outcomes.","authors":"Zoe Shaked, Chiara Eitner, Claudius Jelgersma, Anton Früh, Ran Xu, Helena Radbruch, Jawed Nawabi, Felix Ehret, Güliz Acker, Daniel Zips, Lars Wessels, Ulrich Keilholz, Julia Onken, Martin Misch, Peter Vajkoczy, David Wasilewski","doi":"10.1016/j.bas.2026.106660","DOIUrl":"https://doi.org/10.1016/j.bas.2026.106660","url":null,"abstract":"<p><strong>Introduction: </strong>Despite affecting 5-15% of metastatic cancer patients, leptomeningeal disease (LMD), and spinal LMD (sLMD) in particular, remain largely understudied.</p><p><strong>Research question: </strong>This study evaluates the clinical presentation, diagnosis, treatment, and outcomes of sLMD.</p><p><strong>Material and methods: </strong>We retrospectively analyzed sLMD patients treated at a tertiary center (2011-2024) who underwent cranial and spinal imaging within 30 days of LMD diagnosis. Survival analysis was performed using Kaplan-Meier curves, with a multivariable Cox regression model being employed to identify independent prognostic factors using a stepwise backwards approach.</p><p><strong>Results: </strong>Fifty-two patients (median age: 57.9 years, 63.5% female) were included. Breast cancer (30.8%) and NSCLC (25.0%) were the most common primary malignancies. Median time from primary disease diagnosis to LMD diagnosis was 30.2 months [95% CI: 18.9-42.6]. LMD was diagnosed in 51.9% of cases through imaging and in 48.1% through imaging and CSF cytology. At diagnosis, 92.3% had concurrent cranial and spinal LMD, 67.3% brain metastases, 50.0% vertebral metastases, and 19.2% intraspinal metastases. The most common symptoms were clinical decline (80.8%) and headaches (59.6%). Spine-related symptoms included radiculopathy (26.9%) and paraplegia (23.1%). Median overall survival was 2.7 months [95% CI: 2.0-4.1]. Independent prognostic factors for improved survival included systemic therapy following LMD diagnosis (HR = 0.40, p < 0.01), absence of cranial nerve deficits (HR = 0.45, p < 0.05) and absence of gait imbalance (HR = 0.50, p < 0.05) at LMD diagnosis.</p><p><strong>Discussion and conclusion: </strong>By highlighting the clinical challenges, heterogenous treatment regimens and poor prognosis associated with sLMD, this study serves as a foundation for further research aimed at improving management strategies and outcomes for this patient cohort.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106660"},"PeriodicalIF":2.7,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for craniocervical instability and spinal cord compression in children with Mucopolysaccharidosis type IV: A systematic review.","authors":"A Peene, B Depreitere","doi":"10.1016/j.bas.2026.106658","DOIUrl":"10.1016/j.bas.2026.106658","url":null,"abstract":"<p><strong>Introduction: </strong>Mucopolysaccharidosis type IV (MPS IV) often leads to instability and spinal cord compression at the craniocervical junction in children, confronting surgeons with technical challenges associated with young age.</p><p><strong>Research question: </strong>This systematic review examines the effects of age at surgery and type of fixation on achieving craniocervical bony fusion and the impact of decompression and solid fusion on neurological outcomes.</p><p><strong>Material and methods: </strong>We systematically searched PubMed/MEDLINE, Embase, Web of Science, Scopus and Cochrane Library for cohorts reporting on 'Craniocervical instability', 'Spinal cord compression' and 'Mucopolysaccharidosis type IV' up till April 27, 2024. Inclusion criteria were MPS IV, craniocervical instability treatment and age ≤ 16 years.</p><p><strong>Results: </strong>Eighteen studies were included, comprising 114 patients with a median age at surgery of 72.0 months (range: 17.0-191.0). A total of 88.6% (n = 101/114) of patients underwent craniocervical junction surgery, with rigid fixation used in 17.8% (n = 13/73) and decompression performed in 63.8% (n = 44/69) of cases. Craniocervical bony fusion was achieved in 93.8% (n = 91/97) of patients. Rigid fixation was less often used in children younger than three years (20.0%, n = 2/10), but fusion rate remained as high as 77.8% (n = 7/9). No statistically significant association between fixation type and bony fusion was detected (OR = 2.44, 95% CI 0.24-330.60, p = 0.51). There was a trend for neurological outcome to be better after performing decompression (OR = 4.48, 95% CI 0.87-23.26, p = 0.07).</p><p><strong>Discussion and conclusion: </strong>Although rigid fixation was less often applied in children below the age of three, fusion and neurological outcomes were reasonably favorable. There was a trend toward better neurological outcome in patients undergoing decompression.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106658"},"PeriodicalIF":2.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the necessity of edema-sensitive imaging in assessing fragility fractures of the pelvis: a retrospective cohort study utilizing the OF Pelvis Classification and Score.","authors":"Mark Unthan, Felix Kohler, Florian Bürckenmeyer, Camilla Heinen, Philipp Schenk, Tobias Franiel, Bernhard W Ullrich","doi":"10.1016/j.bas.2026.106656","DOIUrl":"10.1016/j.bas.2026.106656","url":null,"abstract":"<p><strong>Introduction: </strong>The incremental value of edema-sensitive imaging beyond CT in fragility fractures of the pelvis (FFP) remains debated.</p><p><strong>Research question: </strong>Does edema-sensitive MRI provide incremental diagnostic value beyond CT for FFP, and does this influence Osteoporotic Fracture (OF) Pelvis scoring and treatment planning?</p><p><strong>Materials and methods: </strong>In a prospective, single-center diagnostic cohort (April 2021-February 2022), adults with suspected FFP underwent pelvic CT and MRI. OF Pelvis types I-V and the OF Pelvis Score were determined; the score was calculated once with CT information and again with MRI information (retrospective). Primary outcomes were CT sensitivity and specificity for detecting clinically relevant injury (OFP III-V vs. I-II). Secondary outcomes included differences in the OF Pelvis Score and concordance of treatment recommendations.</p><p><strong>Results: </strong>Among 85 screened, 44 were analyzed (31 female, 13 male; mean age 80, range 54-94). CT showed sensitivity 86.9% (95% CI 71.9-95.5); specificity 66.7% (95% CI 29.9-92.5). MRI increased mean OF Pelvis Score (4.25 ± 3.31) versus CT obtained OF Pelvis Score (3.48 ± 3.83; p = 0.029). Despite the score shift, CT- and MRI-based treatment recommendations did not differ significantly (p = 0.317). Nine patients underwent surgery; one CT-missed unilateral sacral fracture required surgery after mobilization failure.</p><p><strong>Discussion and conclusion: </strong>CT showed high sensitivity for clinically relevant OF Pelvis III-V injuries; MRI modestly increased the OF Pelvis Score without materially changing management. A CT-first strategy for routine FFP assessment is supported, with edema-sensitive imaging reserved for diagnostic uncertainty or discordant findings.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106656"},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148898307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcome measure completion in lumbar spine surgery: Rates and determinants in a multicenter registry.","authors":"Julia Mocking, Judith M P van Grafhorst, Christian Herrmann, Emin Aghayev, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.bas.2026.106286","DOIUrl":"10.1016/j.bas.2026.106286","url":null,"abstract":"<p><strong>Introduction: </strong>Patient-reported outcome measures (PROMs) are increasingly used to aid clinical decision-making, evaluate treatment outcomes, and support quality improvement in spine care. However, to ensure valid and representative outcomes, sufficient completion rates are crucial.</p><p><strong>Research question: </strong>The objective of this study is to assess PROM completion rates in routine lumbar spine surgery care and to identify patient- and hospital-level factors associated with completion.</p><p><strong>Materials and methods: </strong>Data were obtained from patients undergoing low-complex lumbar spine surgery for degeneration, with and without instrumentation, recorded in the Spine Tango Registry. PROM completion was assessed as completion of any, baseline, or follow-up PROM, and paired baseline and follow-up PROMs. Mixed-effects logistic regression models were used to evaluate associations between PROM completion and patient characteristics (e.g. age, diagnosis, surgical procedure) and to describe hospital- and country-level variability. Additionally, an exploratory survey among participating hospitals assessed PROM collection strategies.</p><p><strong>Results: </strong>A total of 1810 patients from 5 countries were included. Overall, 67.3% of patients completed at least one PROM, 57.9% completed a baseline PROM, 53.3% completed a follow-up PROM and 44.4% completed paired baseline and follow-up PROMs. Completion rates declined with increasing follow-up duration. Age, diagnosis, and type of surgery were significantly associated with PROM completion. Substantial variability in PROM completion was observed between hospitals.</p><p><strong>Discussion and conclusion: </strong>PROM completion in routine lumbar spine surgery care remains suboptimal, particularly for long-term follow-up and paired PROMs. The large variability between hospitals indicates that hospital-level interventions are crucial to improve PROM completeness and ensure reliable outcome assessment.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106286"},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding calvarial lesions: Contemporary neurosurgical management integrating radiological and histopathological features.","authors":"Biyan Nathanael Harapan, Antonia Clarissa Wehn, Viktoria Ruf, Thomas Liebig, Willy R Hube, Luis Kuschel, Florian Ringel, Veit M Stöcklein, Michael Schmutzer-Sondergeld","doi":"10.1016/j.bas.2026.106655","DOIUrl":"10.1016/j.bas.2026.106655","url":null,"abstract":"<p><strong>Introduction: </strong>Calvarial lesions range from benign tumors to malignant processes and pose diagnostic and surgical challenges due to their rarity and heterogeneous imaging features.</p><p><strong>Research question: </strong>Which clinical and radiological features distinguish benign from malignant calvarial lesions, and how do they influence neurosurgical management and outcomes?</p><p><strong>Material and methods: </strong>We performed a retrospective study of patients undergoing neurosurgical treatment for calvarial lesions between 2013 and 2025. Clinical, radiological, surgical, and histopathological data were analyzed. Functional outcomes (KPS, GOS, mRS), comorbidity measures (ASA classification, BMI), and frailty (modified 5-Item Frailty Index) were assessed. Imaging evaluation included CT-based bone morphology and MRI.</p><p><strong>Results: </strong>A total of 174 patients were included; 66.1% had benign and 33.9% malignant lesions. Malignant lesions were associated with older age, higher frailty, and comorbidity burden. The most common diagnoses were meningioma and metastases. Multiple osteolytic lesions on CT were associated with malignancy and remained the strongest independent predictor (OR: 5.34; 95% CI: 2.35-12.14). Gross total resection was achieved in 82.8% of cases (83.5% in benign vs. 81.3% in malignant lesions, p = 0.8), with significant postoperative functional improvement (KPS), particularly in benign lesions (p < 0.0001). Overall, recurrence occurred in 3.4% of patients and was more frequent in malignant than benign lesions (6.8% vs. 1.7%, p = 0.2).</p><p><strong>Discussion and conclusion: </strong>Multiple osteolytic lesions represent a key radiological marker of malignancy and support preoperative risk stratification. Distinguishing benign from malignant lesions is essential, as it informs surgical strategy and the extent of resection, enabling individualized patient management.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106655"},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524643/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early surgery vs. conservative management for traumatic intracerebral hematoma: A systematic review and Bayesian meta-analysis.","authors":"Plamen Penchev, Daniela Milanova-Ilieva, Lyubomir Gaydarski, Kishanth Reghunathan, Jorge Eduardo Alonso-Vera, Grigor Grigorov, Petar-Preslav Petrov, Pavel Stanchev, Laurens Noack, Nikolai Ramadanov","doi":"10.1016/j.bas.2026.106263","DOIUrl":"10.1016/j.bas.2026.106263","url":null,"abstract":"<p><strong>Introduction: </strong>The management of traumatic intracerebral hematoma (TICH) remains controversial. This Bayesian meta-analysis evaluated the effects of early surgery versus conservative treatment on mortality, unfavourable functional outcome, and hospital length of stay.</p><p><strong>Methods: </strong>PubMed, Scopus, and the Cochrane Library were searched from inception to 15 December 2025 (PROSPERO CRD420251248144) for studies comparing early surgery with conservative treatment in patients with TICH. Outcomes included mortality reported at the study-specific available assessment time, ranging from the in-hospital period to 6 months, unfavourable functional outcome assessed at 3 or 6 months, and hospital length of stay. Bayesian random-effects models were fitted using vague priors for overall effects and informative or weakly informative priors for between-study heterogeneity. Sensitivity analyses with alternative prior specifications were performed. Posterior probabilities (PPs), 95% credible intervals (CrIs), and posterior predictive distributions were estimated.</p><p><strong>Results: </strong>Four studies, including two randomized controlled trials and two observational studies comprising 664 patients were included. Early surgery showed no clear reduction in mortality (OR 0.90; 95% CrI [0.50; 1.56]; PP OR < 1: 65%) or unfavourable functional outcome (OR 1.16; 95% CrI [0.57; 2.43]; PP OR < 1: 31%). Early surgery was associated with a low probability of reducing hospital length of stay (MD 3.00 days; 95% CrI [-0.79; 7.18]; PP MD < 0: 5%). Subgroup analyses suggested potential differences according to study design and risk of bias, although predictive distributions indicated substantial uncertainty.</p><p><strong>Conclusion: </strong>Current evidence does not demonstrate a clear benefit of routine early surgery over conservative treatment for TICH and shows an uncertain trend toward longer hospital stay, which should be interpreted cautiously given imprecision and potential confounding by indication. Early surgery should therefore be considered selectively pending further high-quality randomized evidence.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106263"},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13524587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Microsurgical, Endovascular, Multimodal, and Radiosurgical Management of Spinal Intramedullary Arteriovenous Malformations: A Systematic Review and Exploratory Meta-Analysis.","authors":"Badr Hafiz, Thamer Alsharif, Fahad Okal, Faisal Sukkar, Yazeed Alotaibi, Lamair Albakri, Khalid Bajunaid, Saleh Baeesa","doi":"10.1016/j.bas.2026.106654","DOIUrl":"10.1016/j.bas.2026.106654","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal intramedullary arteriovenous malformations (Si-AVMs) are rare lesions determined by angioarchitecture, location, clinical presentation, and procedural intent, making comparisons between modalities vulnerable to confounding by indication.</p><p><strong>Research question: </strong>To characterize radiographic, functional, and safety outcomes after microsurgical, endovascular, combined, and radiosurgical management of Takai Type II/III Si-AVMs while distinguishing complete treatment, planned partial embolization, residual disease, recanalization, and multimodality care.</p><p><strong>Materials and methods: </strong>A PRISMA-guided systematic review and exploratory meta-analysis of studies published from 2000 to 2024 included seven retrospective studies comprising up to 672 Type II/III or nidus-type lesions. Treatment pathways and embolization intent were analyzed separately. Combined-treatment patients were retained as a distinct group unless outcomes were disaggregated. Because outcome definitions were heterogeneous, pooled estimates were considered descriptive and hypothesis-generating.</p><p><strong>Results: </strong>Microsurgical series generally reported higher complete angiographic obliteration than embolization-only series; however, lesion selection and planned multimodality treatment precluded causal comparison. In the largest cohort, 68/258 (26.4%) embolization-only patients achieved complete obliteration. Recanalization occurred in 15/30 (50.0%) lesions initially considered completely obliterated and in 73/219 (33.3%) embolized lesions. After partial embolization, lesion proliferation and de novo aneurysm formation each occurred in 22/191 (11.5%) patients. Permanent neurological deterioration occurred more often after microsurgery than embolization (16.1% vs. 5.6%).</p><p><strong>Discussion and conclusion: </strong>The available evidence supports lesion-specific, complementary use of microsurgery, embolization, combined treatment, and radiosurgery rather than modality-wide superiority. Microsurgery may provide durable obliteration in selected lesions, whereas embolization may be curative, staged, neoadjuvant, or palliative. Radiosurgery remains a niche option for selected, inaccessible lesions. All conclusions are hypothesis-generating.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106654"},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative cone-beam CT for real-time quality control in CSF shunt surgery: a prospective workflow study.","authors":"Lina-Elisabeth Qasem, Dilara Karakaya, Christian Seemann, Nadine Angelika Döpke, Leonhard Mann, Fee Keil, Fatma Kilinç, Paul Kendlbacher, Marcus Czabanka, Vincent Prinz","doi":"10.1016/j.bas.2026.106269","DOIUrl":"10.1016/j.bas.2026.106269","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative CT is routinely performed after cerebrospinal fluid (CSF) shunt implantation to verify catheter position. Intraoperative cone-beam CT (iCBCT) enables real-time verification and may obviate routine postoperative CT.</p><p><strong>Research question: </strong>Does an iCBCT-based workflow reduce radiation exposure and permit omission of routine postoperative CT?</p><p><strong>Methods: </strong>This interim analysis of an ongoing, prospective, observational study enrolled 10 patients undergoing ventriculoperitoneal (VP), lumboperitoneal (LP), ventriculoatrial (VA), or cyst shunt implantation with iCBCT-based quality control and compared them with a matched retrospective cohort of 10 patients managed by conventional postoperative CT. The primary endpoint was radiation exposure. Secondary endpoints were operative duration and the number of immediate revisions for catheter malposition.</p><p><strong>Results: </strong>The volumetric dose index was lower in the iCBCT group than in the control group (CBDIw median 9.27 mGy [IQR, 6.5-11.5] vs CTDIvol 31.15 mGy [IQR, 23.5-34.2]; p = 0.002). Intraoperative imaging detected catheter malposition in one VP shunt and enabled immediate revision within the same surgical session. Routine postoperative CT was omitted in all iCBCT patients, without catheter-related complications through the routine 2-3-week postoperative follow-up. OR time was longer in the iCBCT group due to image acquisition without statistical significance (median 142 min [IQR, 114-157] vs 127 min [IQR, 104-140]; p = 0.2948). Surgical time was comparable between groups (median 65.5 min [IQR, 54-80] vs 60 min [IQR, 50-76]; p = 0.590).</p><p><strong>Discussion and conclusion: </strong>In this interim cohort, iCBCT lowered the radiation dose index and replaced postoperative CT, enabling real-time catheter verification across CSF shunts.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"106269"},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13521095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}