Brain & spine最新文献

{"title":"Revisiting sylvian fissure dissection - A preliminary investigation into surgical process modelling for evaluating surgical proficiency","authors":"Félix Buyck ,&nbsp;Jef Vandemeulebroucke ,&nbsp;Ine Dirks ,&nbsp;Jan Frederick Cornelius ,&nbsp;Johnny Duerinck ,&nbsp;Sebastien Froelich ,&nbsp;Henry Schroeder ,&nbsp;Wietse Geens ,&nbsp;Frederick Van Gestel ,&nbsp;Michaël Bruneau","doi":"10.1016/j.bas.2025.104284","DOIUrl":"10.1016/j.bas.2025.104284","url":null,"abstract":"<div><h3>Introduction</h3><div>Understanding the factors that contribute to efficient surgical behaviour and the prevention of technical errors poses a significant challenge in neurosurgery. Current training curricula lack proficiency-centred training and objective tools to assess surgical performance, leading to considerable variability in surgical competencies and practices among neurosurgeons. This study aims to evaluate the determinants of proficient surgical behaviour exhibited by expert surgeons, with the goal of establishing a set of surgical performance metrics serving as a foundation for objective assessment and benchmarking of surgical performance.</div></div><div><h3>Material and methods</h3><div>Eight aneurysm clipping cases by three senior neurosurgeons were recorded via a surgical microscope. Surgeons' actions, workflow parameters, and adverse events during Sylvian fissure dissection were catalogued into Surgical Process Models (SPMs). Performance metrics were extracted, compared, and analysed using clustering analysis to assess proficiency differences.</div></div><div><h3>Results</h3><div>23 parameters were identified as potential metrics of surgical proficiency. Proficient surgeons exhibited predominant bimanual activity, optimal non-dominant hand use, a limited tool repertoire, minimal instrument changes, and efficient microscope use with minimal adjustments. Despite varying instrument and microscope usage, practitioners achieved consistent outcomes across metrics, indicating similar surgical proficiency.</div></div><div><h3>Discussion and conclusion</h3><div>Findings illustrate that performance metrics derived from surgical video analysis can reliably contribute to the assessment of surgical skills. SPMs offer a structured understanding of the factors that contribute to surgical proficiency. This approach provides an optimal framework for objective assessment of performance metrics, demonstrating potential for automated and objective analysis of surgical performance.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104284"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive role of family history of antipsychotic drug use in poor outcomes following aneurysmal subarachnoid hemorrhage (aSAH)","authors":"Juho Paavola ,&nbsp;Terhi Huuskonen ,&nbsp;Mikael von und zu Fraunberg ,&nbsp;Timo Koivisto ,&nbsp;Olli-Pekka Kämäräinen ,&nbsp;Maarit Lång ,&nbsp;Markku Lähteenvuo ,&nbsp;Juha E. Jääskeläinen ,&nbsp;Jukka Huttunen ,&nbsp;Antti Lindgren","doi":"10.1016/j.bas.2025.104317","DOIUrl":"10.1016/j.bas.2025.104317","url":null,"abstract":"<div><h3>Introduction</h3><div>Aneurysmal subarachnoid hemorrhage (aSAH) primarily impacts the working-age population. We have shown that 12-month survivors of aSAH from a defined population have increased use of antipsychotic drugs (APD) after aSAH.</div></div><div><h3>Research question</h3><div>Does familial psychiatric burden associate with the risk of APD use or having a poor outcome (mRS 3–5) after aSAH?</div></div><div><h3>Material and methods</h3><div>In our retrospective case-control study, we included consecutive 12-month survivors of aSAH admitted to Kuopio University Hospital with a first aSAH from 1995 to 2018 from its defined catchment population. From national health registries, data were retrieved and linked to aSAH patients, relatives, and matched population controls.</div></div><div><h3>Results</h3><div>Of 1347 aSAH patients (median age 54; 53 % females, median follow-up 11 years), a total of 187 (14 %) had started APD use only after the aSAH. Among 10 820 relatives, 1070 (10 %) with APD use were identified. In overall, 79 aSAH survivors with a family history of APD use or psychiatric diagnoses were not at increased risk of initiating APD use after aSAH (OR 0.79, 95 % CI 0.58–1.09). 84 (51 %) of 166 aSAH survivors with a 12-month poor outcome had a positive family history. Positive family history was an independent risk for poor outcome (OR 1.87, 95 % CI 1.28–2.73).</div></div><div><h3>Discussion and conclusion</h3><div>The family history of APD use or psychiatric diagnoses was not a risk factor for APD use but was an independent risk factor for poor outcome at 12 months after aSAH. This should be considered in the rehabilitation and follow-up programs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104317"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Sagittal Spinal Alignment of Patients with symptomatic Lumbar Spinal Stenosis with Healthy Controls: A Systematic Review and Meta-Analysis","authors":"V. Cara ,&nbsp;S. Li ,&nbsp;C. Nüesch ,&nbsp;F. Halbeisen ,&nbsp;C. Appenzeller-Herzog ,&nbsp;S. Schären ,&nbsp;C. Netzer","doi":"10.1016/j.bas.2025.104364","DOIUrl":"10.1016/j.bas.2025.104364","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104364"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstructing the Past: Innovative Surgical Approaches for the Management of Kummell’s Syndrome","authors":"D. Valsecchi ,&nbsp;F. Ramadani ,&nbsp;G. Maestretti","doi":"10.1016/j.bas.2025.104371","DOIUrl":"10.1016/j.bas.2025.104371","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104371"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing spatio-temporal, kinematic and kinetic gait parameters in patients with degenerative cervical spinal stenosis","authors":"F. Mandelli ,&nbsp;R. Cottier ,&nbsp;C. Nüesch ,&nbsp;A. Mündermann ,&nbsp;S. Schären ,&nbsp;C. Netzer","doi":"10.1016/j.bas.2025.104340","DOIUrl":"10.1016/j.bas.2025.104340","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104340"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144911545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Structural versus Functionally-informed Supratotal Resection: Where do we stand?","authors":"Yasir A. Chowdhury ,&nbsp;Richard Gullan ,&nbsp;Keyoumars Ashkan ,&nbsp;Francesco Vergani ,&nbsp;Ranjeev Bhangoo ,&nbsp;José Pedro Lavrador","doi":"10.1016/j.bas.2025.104398","DOIUrl":"10.1016/j.bas.2025.104398","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104398"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144919737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can the supine extended position with legs straightened and a lumbar pillow complement the psoas-relaxed position for the diagnosis of lumbar spinal stenosis on MRI? A prospective cross-sectional study","authors":"Liqa A. Rousan ,&nbsp;Naser Obeidat ,&nbsp;Ahmad Abdalmajeed Alghzawi ,&nbsp;Mays Al-Jarrah ,&nbsp;Luca Papavero","doi":"10.1016/j.bas.2025.104377","DOIUrl":"10.1016/j.bas.2025.104377","url":null,"abstract":"<div><h3>Introduction</h3><div>When the diagnosis of lumbar spinal stenosis is uncertain in the conventional psoas-relaxed position (PRP) MRI, upright MRI is a not widely available alternative. The aim of this study was to investigate whether a modified supine MRI position with legs straight and an adjustable pillow under the lumbar spine (EXT) could mimic the effect of standing.</div></div><div><h3>Research question</h3><div>We hypothesized that EXT would mimic upright MRI in stenosis severity.</div></div><div><h3>Materials and methods</h3><div>Forty patients (58 % male, mean age 57 years) underwent a 3T (65 %) or 1.5T MRI. For the levels L2-S1, central stenosis (Lee: 0–3), dural cross sectional area (DCSA: mm²); lateral recess stenosis (Bartinsky: 0–3), foraminal stenosis (Lee: 0–3) and lordosis angle (LA: L1-S1°) were measured in PRP and EXT by three radiologists. Cohen's kappa and Cronbach's alpha for intra/interrater reliability and Pearson's correlation coefficient between PRP and EXT were measured. P &lt; 0.05 was used for statistical significance.</div></div><div><h3>Results</h3><div>At L4/L5 EXT showed increased narrowing in 40 % (central), 37.5 % (lateral), and 17.5 % (foraminal). DCSA decreased (P &lt; 0.0001) and LA increased (P &lt; 0.0001), with strong correlations and high reliability (P &lt; 0.0001). Lateral recess stenosis increased significantly in EXT at L4/L5 (P = 0.014; K = 0.646). No significant difference was observed in foraminal stenosis (K = 0.488).</div></div><div><h3>Discussion and conclusion</h3><div>EXT increased lumbar lordosis to the normal standing range of approximately 50°, mimicking an upright MRI. A more realistic degree of central stenosis at all levels and of lateral recess stenosis at L4/L5 was shown. Foraminal stenosis did not increase.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104377"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144763871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex and age differences in patients treated surgically for acute subdural hematoma","authors":"Anna Koller ,&nbsp;Christoph Reich ,&nbsp;Claudius Thomé ,&nbsp;Daniel Pinggera","doi":"10.1016/j.bas.2025.105602","DOIUrl":"10.1016/j.bas.2025.105602","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute subdural hematoma (aSDH) is a severe condition with high mortality despite advances in neurosurgical care. Predicting outcomes remains challenging due to individual variability. This study explores sex- and age-related differences in surgical treatment and outcomes of aSDH.</div></div><div><h3>Research question</h3><div>How does sex and age influence surgical decision-making and outcomes in patients undergoing surgery for acute subdural hematoma?</div></div><div><h3>Material and methods</h3><div>We retrospectively analyzed 328 patients treated surgically for aSDH between 2005 and 2015. Demographic data, clinical characteristics (GCS), radiological parameters, surgical approach (osteoplastic craniotomy [OC] vs. decompressive craniectomy [DC]), and outcomes (Glasgow Outcome Scale [GOS]) at discharge were collected.</div></div><div><h3>Results</h3><div>The cohort included 211 men (mean age: 56) and 117 women (mean age: 68). Hematoma volumes were similar between sexes (p = 0.9), yet surgical choices differed significantly (OC in 58 % of women vs. 43 % of men; p = 0.008). Elderly patients (&gt;70 years; n = 133) had larger hematoma volumes than younger patients (64.6 vs. 44.8 cm³; p &lt; 0.0001) and were more frequently treated with OC (68 % vs. 35 %; p &lt; 0.0001). Age and hematoma volume—but not sex—were independent predictors of surgical approach. Outcome (GOS) was worse in elderly patients (p &lt; 0.001) and those undergoing DC (p = 0.001). Time to CT correlated with outcome (p = 0.001), while time to surgery did not.</div></div><div><h3>Discussion and conclusion</h3><div>Despite comparable hematoma volumes, surgical strategies varied by sex and age. Elderly patients with larger hematomas were less likely to receive DC. These findings highlight demographic influences on surgical decision-making and support a more individualized approach in managing aSDH.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 105602"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of routine cranial CT imaging in geriatric head trauma: a retrospective analysis from a level I trauma centre in Germany","authors":"Josina Straub ,&nbsp;Julia Elisabeth Lenz ,&nbsp;Leopold Henssler ,&nbsp;Kristina Gerhardinger ,&nbsp;Lisa Klute ,&nbsp;Borys Frankewycz ,&nbsp;Amr Mohamed ,&nbsp;Volker Alt ,&nbsp;Daniel Popp ,&nbsp;Siegmund Lang ,&nbsp;Maximilian Kerschbaum","doi":"10.1016/j.bas.2025.105606","DOIUrl":"10.1016/j.bas.2025.105606","url":null,"abstract":"<div><h3>Introduction</h3><div>Geriatric patients with head trauma have an increased risk of intracranial injuries. Due to impaired clinical evaluability and the widespread antithrombotic use, cranial computertomography (cCT) is frequently performed.</div></div><div><h3>Research question</h3><div>This study aims to determine the prevalence and risk factors for intracranial haemorrhage and to calculate the number needed to screen (NNS) for its detection in a geriatric cohort.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients aged ≥65 years presenting to a level I trauma centre in Germany between January 2020 and October 2024 after a head impact and undergoing cCT imaging.</div></div><div><h3>Results</h3><div>Among 2474 patients, 62.9 % were aged ≥80 years and 56.1 % were female. Intracranial haemorrhage occurred in 9.3 %, with 1.5 % requiring surgery. Risk factors for intracranial haemorrhage included female gender (OR = 1.4; p = 0.014), impaired consciousness (OR = 3.5; p &lt; 0.001), presentation via resuscitation room (OR = 6.5; p &lt; 0.001) and cervical spine injury (OR = 2.2; p &lt; 0.001). The NNS for detecting intracranial haemorrhage was 10.7 in patients aged ≥65 years and 11.4 in those aged ≥80 years. The NNS in patients without impaired consciousness was 19.2 for those aged ≥65 years and 20.5 for those aged ≥80 years. The NNS for surgical intervention was 65.1 in patients aged ≥65 years and 111.1 in those aged ≥80 years.</div></div><div><h3>Discussion and conclusion</h3><div>Intracranial haemorrhage is a common consequence of head trauma in older patients. Despite its high frequency, routine cCT is crucial for timely identification of acute intracranial pathologies, with the low NNS highlighting its diagnostic value and justifying its widespread use to optimize patients’ outcomes.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 105606"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcomes in pediatric brain AVMs: beyond radiological cure","authors":"Francesco M.C. Lioi ,&nbsp;Alessandro De Benedictis ,&nbsp;Davide Luglietto ,&nbsp;Franco Randi ,&nbsp;Carlo Gandolfo ,&nbsp;Giulia Lucignani ,&nbsp;Maria Lopez Gutierrez ,&nbsp;Carlo E. Marras","doi":"10.1016/j.bas.2025.105609","DOIUrl":"10.1016/j.bas.2025.105609","url":null,"abstract":"<div><h3>Background</h3><div>Brain AVMs are typically considered cured after angiographic confirmation of nidus obliteration. However, in pediatric patients, recurrence can occur many years later, underscoring the need for long-term clinical surveillance. Event-free survival (EFS) represents a complementary, exploratory metric of therapeutic <strong>success</strong> that captures time-dependent morbidity.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 46 pediatric patients with brain arteriovenous malformations (bAVMs) treated between 2013 and 2025. Clinical data, bAVM characteristics, treatment strategies, and outcomes were systematically collected. EFS was defined as the absence of clinically significant neurological complications throughout follow-up, whether early or late, and attributable to bAVM natural history or treatment-related effects. Kaplan–Meier survival analysis was performed to assess EFS by radiological cure status. Long-term functional outcomes were evaluated using the modified Rankin Scale (mRS).</div></div><div><h3>Results</h3><div>Median age was 9.8 years; 78.3 % presented with hemorrhage. Radiological cure was achieved in 77.5 % of patients completing treatment. At final follow-up (median 56.5 months; 64 months in the EFS subset), 87 % had a favorable outcome (mRS ≤2). Clinical events occurred both early (≤30 days) and late (&gt;30 days), with late events predominating. Over 30 % of patients with confirmed radiological cure experienced events. Long-term events were not associated with hemorrhagic onset, nor with urgent surgical treatment, suggesting they are not merely acute-phase complications. Two angiographic recurrences occurred after more than 9 years.</div></div><div><h3>Conclusion</h3><div>Event-free survival (EFS) is a complementary metric that reflects long-term morbidity from both natural history and treatments, highlighting the persistence of events beyond radiological cure and supporting extended follow-up in pediatric AVMs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 105609"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}