Brain & spine最新文献

{"title":"Review of treatment modalities and clinical outcome of giant saccular posterior cerebral artery aneurysms","authors":"Andreas Theofanopoulos ,&nbsp;Rajiv Kumar Khajuria ,&nbsp;Dilaware Khan ,&nbsp;Lucas Troude ,&nbsp;Ben Waldau ,&nbsp;Katharina Faust ,&nbsp;Sajjad Muhammad","doi":"10.1016/j.bas.2025.104309","DOIUrl":"10.1016/j.bas.2025.104309","url":null,"abstract":"<div><h3>Introduction</h3><div>Giant saccular posterior cerebral artery (PCA) aneurysms are rare lesions carrying significant morbidity due to mass effect and present therapeutic challenges, mainly due to the challenging approach required for aneurysm obliteration.</div></div><div><h3>Research question</h3><div>To review treatment modalities and outcomes of patients harboring giant (&gt;2.5 cm) PCA saccular aneurysms distal to the basilar bifurcation.</div></div><div><h3>Materials and methods</h3><div>A systematic literature review through PubMed and Scopus to identify cases of giant saccular PCA aneurysms treated either microsurgically or endovascularly. Patients’ demographics, aneurysm size, preoperative and postoperative neurologic status, clinical outcomes and follow-up information were retrieved.</div></div><div><h3>Results</h3><div>Data from 33 studies including 55 patients were obtained. Mean patient age was 34.35 years. Mean maximum aneurysm diameter was 38.48 mm. Presentation was aneurysm rupture in 30.9 %, headache in 23.6 %, hemiparesis or tetraparesis in 12.7 %, hemianopsia in 10.9 % and hydrocephalus in 5.5 %. At least 30.9 % had significant brainstem compression. Treatment was endovascular in 23.6 %, microsurgical in 67.3 % and combined in 9.1 %. Debulking to reduce mass effect was required in 32.4 %. Preoperative mRS ranged from 1 to 5. A favorable outcome (mRS 0–2) was reported on 92.7 % of cases. Death rate was 3.6 %. The PCA was sacrificed in 40 % of the patients without severe neurologic morbidity. Follow-up ranged from 1 week to 11 years.</div></div><div><h3>Discussion and conclusion</h3><div>Giant PCA aneurysms are amenable to both treatment modalities. PCA sacrifice may be required and is often well tolerated, presumably due to the rich collateral supply. Mass effect may necessitate debulking. PCA bypass may be required, but carries significant morbidity.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104309"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144570290","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":"Functional-guided frameless stereotactic biopsy of highly eloquent brain tumors","authors":"Maximilian Schwendner ,&nbsp;Axel Schroeder ,&nbsp;Bernhard Meyer ,&nbsp;Sandro M. Krieg ,&nbsp;Sebastian Ille","doi":"10.1016/j.bas.2025.104289","DOIUrl":"10.1016/j.bas.2025.104289","url":null,"abstract":"<div><h3>Objective</h3><div>Regarding diagnostics and treatment planning, intracranial mass lesions often require needle biopsies. Despite being performed with minimum invasiveness, biopsy-related functional deficits may still occur. Navigated transcranial magnetic stimulation (nTMS) enables preoperative non-invasive identification of eloquent brain areas. In addition, nTMS-based tractography can visualize eloquent white matter pathways. This study evaluated the usefulness and clinical impact of non-invasive cortical mapping and tractography of eloquent brain functions for trajectory planning before stereotactic biopsies.</div></div><div><h3>Methods</h3><div>Cortical nTMS data and nTMS-based tractography of motor and language function were integrated into the routine workflow of trajectory planning before biopsies. Intraoperative data, histopathological findings, and clinical outcomes were analyzed. Furthermore, a matched-pair analysis comparing cases with and without cortical nTMS data and nTMS-based tractography was performed.</div></div><div><h3>Results</h3><div>Between March 2018 and March 2023, 45 stereotactic frameless biopsies of eloquent brain lesions with preoperative nTMS mappings and nTMS-based tractography (16 motor/2 language/27 both) were analyzed. Cortical nTMS data and tractography were considered during trajectory planning in all cases. The diagnostic yield was 84.4 %. Histopathological findings showed HGG in 25 (55.6 %) cases, low-grade-glioma in 5 (11.1 %) patients, lymphoma in 5 patients (11.1 %), and reactive gliosis to rule out tumor progression in 4 cases (8.9 %). Amongst cases with no clear histopathological finding, resection of the lesion was performed in four patients, while one patient underwent repeated biopsy. One case of language deterioration resolved after admission of corticosteroids, and two cases of progressive motor decline related to extensive tumor progress on MRI were observed during hospitalization. Postoperative computed tomography imaging in these three cases revealed no postoperative hemorrhage. In the matched cohort, the diagnostic yield was 84.4 % (p &gt; 0.999). However, a higher rate of neurological deficits was observed (13.3 %; p = 0.292).</div></div><div><h3>Conclusions</h3><div>Non-invasive functional data can easily be integrated into trajectory planning workflow for frameless stereotactic biopsies. The reliable visualization of eloquent cortical and subcortical regions facilitates the planning process and might avoid surgery-related neurological deficits.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104289"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204382","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":"Nimodipine after aneurysmal subarachnoid hemorrhage: shortened treatment in an unselected patient cohort","authors":"Bryndís Baldvinsdóttir ,&nbsp;Peo Wästberg ,&nbsp;Björn M. Hansen ,&nbsp;Erik Uvelius ,&nbsp;Erik Kronvall","doi":"10.1016/j.bas.2025.104376","DOIUrl":"10.1016/j.bas.2025.104376","url":null,"abstract":"<div><h3>Background</h3><div>Nimodipine improves outcome after aneurysmal subarachnoid hemorrhage (aSAH) through mitigation of delayed cerebral ischemia (DCI). Most studies are based on a treatment duration of 21 days. At our institution, clinical practice is to administer nimodipine for 14 days, regardless of bleeding severity. Treatment is prolonged if signs or symptoms of DCI occurs. The present study aims to review this practice.</div></div><div><h3>Methods</h3><div>A prospective cohort of aSAH patients was reviewed and relevant information regarding nimodipine treatment were retrospectively added to this database. Functional outcome was measured using Glasgow outcome scale extended (GOSE) one year after ictus and dichotomized into unfavorable and favorable outcome. Radiological outcome was defined by the occurrence of new cerebral infarctions on brain imaging later than 30 days post-ictus.</div></div><div><h3>Results</h3><div>The study population comprised 164 patients, out of which 97 (59 %) received nimodipine for 14 days or less. Unfavorable outcome was noted in 27 % of patients and brain imaging found cerebral infarctions in 17 % of patients. Both outcome measures were similar to previously published studies. No readmissions or signs of DCI were seen after discontinuation of nimodipine.</div></div><div><h3>Conclusions</h3><div>A shortened nimodipine treatment period in patients without DCI after aSAH could be feasible. This may reduce sleep deprivation of patients and more effective utilization of neurointensive care resources. A large, randomized study is required to answer the question whether a shorter treatment with nimodipine is adequate to give full benefit of the medication in patients without signs and symptoms of DCI.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104376"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750093","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 utility of preoperative computed tomography-guided screw marking in thoracic spine surgery","authors":"Christopher Marvin Jesse ,&nbsp;Aatharshan Kannathasan ,&nbsp;Ralph T. Schär ,&nbsp;Johannes Goldberg ,&nbsp;Andreas Raabe ,&nbsp;Jan Gralla ,&nbsp;Johannes Kaesmacher ,&nbsp;Tomas Dobrocky ,&nbsp;Eike Immo Piechowiak","doi":"10.1016/j.bas.2025.104333","DOIUrl":"10.1016/j.bas.2025.104333","url":null,"abstract":"<div><h3>Introduction</h3><div>Wrong-level surgery (WLS) is a preventable yet severe complication in spinal surgery, particularly for pathologies located in the thoracic spine, where localizing the intended level is more challenging compared to the lumbar or cervical spine, which have more distinct landmark structures and fewer vertebral bodies.</div></div><div><h3>Research question</h3><div>Evaluate the impact of preoperative, computed tomography (CT)-guided screw marking on avoiding WLS and optimizing intraoperative workflows.</div></div><div><h3>Material and methods</h3><div>We conducted a retrospective case-control study at Bern University Hospital, enrolling all patients treated with thoracic spinal surgery between February 2017 and August 2022. Patients that received preoperative, CT-guided screw marking in the pedicle at the index level were compared to those without preoperative marking. Data included clinical features, radiological parameters, and complications. Primary endpoint: occurrence of WLS. Secondary endpoints: duration of intraoperative fluoroscopy, operating room (OR) occupancy time, and complications.</div></div><div><h3>Results</h3><div>A total of 117 patients were included: 71 in the screw group and 46 in the control group. The mean age was 54 (±16) years. Significant differences were found in the indication for surgery (p = 0.002). No significant differences were observed in duration of intraoperative fluoroscopy, effective dose, or total OR occupancy time. WLS occurred in only one patient in the control group and none in the screw group. Surgical complications were similar between groups.</div></div><div><h3>Discussion and conclusion</h3><div>We present a safe technique with a low complication rate for preoperative marking of the index vertebra before thoracic spinal surgery, allowing spine surgeons to eliminate the risk of WLS.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104333"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680580","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 value of white blood cell count and platelet count in predicting delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage","authors":"Eva Postma ,&nbsp;Homeyra Labib ,&nbsp;Jordi van Lange ,&nbsp;Bert Coert ,&nbsp;René Post ,&nbsp;René van den Berg ,&nbsp;Charles Majoie ,&nbsp;W. Peter Vandertop ,&nbsp;Dagmar Verbaan","doi":"10.1016/j.bas.2025.104236","DOIUrl":"10.1016/j.bas.2025.104236","url":null,"abstract":"<div><h3>Introduction</h3><div>Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) contributes significantly to mortality and morbidity. Neuroinflammation and platelet activation are implicated in its pathophysiology.</div></div><div><h3>Research question</h3><div>This study evaluates the association of admission white blood cell count (WBC) and platelet count (PC), and their combination, with DCI and explores their integration into predictive models.</div></div><div><h3>Materials and methods</h3><div>This single-center cohort study utilized data from a prospective SAH registry (December 2011–December 2019). Patients with confirmed aSAH and recorded WBC and PC within 72 h post-ictus were included. Univariate and multivariate regression models with established predictors, consisting of the modified Fisher scale (mFS) and World Federation of Neurological Surgeons grade (WFNS), were performed. Predictive values were assessed using AUCs (95 % CI) and C-statistics.</div></div><div><h3>Results</h3><div>Of 954 reviewed patients, 660 met inclusion criteria, with 178 (27.0 %) developing DCI. Patients who developed DCI had significantly higher admission WBC levels (mean (SD) 14.3 (5.1) × 10⁹/L vs. 12.7 (4.8) × 10⁹/L, p &lt; 0.001), whereas admission PC did not differ significantly (median (IQR) 255 (201–301) × 10⁹/L vs. 241 (205–289) × 10⁹/L, p = 0.196). WBC was predictive of DCI (OR 1.06, 1.03–1.10), but PC was not (OR 1.00, 1.00–1.02). Of established predictors, mFS was significant (OR 6.42, 1.96–21.02), whereas WFNS was not (OR 0.79, 0.54–1.15). Among all variables, WBC demonstrated highest predictive value (AUC: 0.59, 0.54–0.64), surpassing mFS and WFNS, or their combination. A combined model incorporating WBC, PC, mFS, and WFNS yielded the highest predictive value (AUC: 0.63, 0.58–0.68).</div></div><div><h3>Discussion and conclusion</h3><div>Admission WBC and PC offer modest predictive value for DCI, either alone or combined with neurological status and hemorrhage burden. However, WBC demonstrated highest predictive value of all investigated variables and modestly improves prediction models. Future research should evaluate WBC’s utility in models with enhanced predictive performance.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104236"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144840937","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":"External Validation of the Timed Up and Go (TUG) Test in Spinal Tumor Patients – First results from the Swiss Spinal Tumor Register (Swiss-STR)","authors":"O.K. Kemp ,&nbsp;S.R. Rüssli ,&nbsp;S.B. Bäbler ,&nbsp;M.Z. Ziga ,&nbsp;E.Z. Nevzati","doi":"10.1016/j.bas.2025.104352","DOIUrl":"10.1016/j.bas.2025.104352","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104352"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912203","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":"Surgical Treatment of Recurrent Lumbar Disc Herniation: To Fuse or not to Fuse? A Single-Center Analysis of clinical and radiological Characteristics and Surgical Outcomes of 450 patients","authors":"G. Fischer ,&nbsp;E. Kilian ,&nbsp;F. Schömig ,&nbsp;J. Vitale ,&nbsp;D. Oriordan ,&nbsp;J. Puhakka ,&nbsp;R. Reitmeir ,&nbsp;M. Ropelato ,&nbsp;D. Haschtmann ,&nbsp;F. Kleinstück ,&nbsp;T. Fekete ,&nbsp;D.J. Jeszenszky ,&nbsp;F. Porchet ,&nbsp;F. Galbusera ,&nbsp;M. Loibl","doi":"10.1016/j.bas.2025.104353","DOIUrl":"10.1016/j.bas.2025.104353","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104353"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144912204","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":"Neurosurgical robot-assisted transnasal endoscopic surgery in orbital-related diseases","authors":"Rui Wu,&nbsp;Gangfeng Sun,&nbsp;Yixin Liu,&nbsp;Shuo Zhang,&nbsp;Xiaopeng Wang,&nbsp;Qiquan Zhu,&nbsp;Guan Wang,&nbsp;Yafei Wang,&nbsp;Weiping Liu","doi":"10.1016/j.bas.2025.104399","DOIUrl":"10.1016/j.bas.2025.104399","url":null,"abstract":"<div><h3>Introduction</h3><div>Transnasal endoscopic surgery, with its minimal invasiveness and no facial incisions, is increasingly used for orbital-related diseases. Robot-assisted techniques enhance precision, safety, and efficacy, offering significant advantages in treating these complex conditions involving multiple anatomical structures and nterdisciplinary considerations.</div></div><div><h3>Research question</h3><div>This study reports our experience using robot-assisted transnasal endoscopic surgery for orbital-related diseases.</div></div><div><h3>Material and methods</h3><div>We retrospectively analyzed 162 patients (March 2021–July 2024) with orbital-related diseases who underwent robot-assisted transnasal endoscopic surgery: 137 optic nerve injuries, 8 orbital tumors, 8 cranio-orbital communication tumors, 5 orbital abscesses, 4 orbital foreign bodies. Outcomes were assessed via clinical follow-up and imaging.</div></div><div><h3>Results</h3><div>161 cases achieved satisfactory treatment without serious complications except for one patient underwent endovascular embolization due to intraoperative bleeding caused by pseudoaneurysm rupture. Among optic nerve injury patients, 66/137 (48.18 %) presented with vision improvement, (36/90 (40 %) were effective in those without light perception, 8/11 (72.73 %) were effective in those with light perception, and 22/36 (61.11 %) were effective in those with better light perception). A 100 % removal rate was achieved in orbital tumors, orbital peripheral abscesses, and foreign bodies. 6/8 (75 %) of cranial-orbital communication tumors were resected completely with the remaining two cases identified pathologically as melanoma and lymphoma.</div></div><div><h3>Discussion and conclusion</h3><div>Robot-assisted transnasal endoscopic surgery is a safe, effective and minimally invasive technique, showing potential advantages in procedures of orbital-related diseases such as optic nerve canal decompression, tumor resection, abscess drainage, and foreign body removal. Preoperative vascular-related examinations can be helpful to reduce the surgery-related complications.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104399"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932199","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":"Best Abstract: Risk Factors for 6-Month Recurrence After Focused Ultrasound in Essential Tremor: Insights from a Stepwise Logistic Regression Model","authors":"Dr. Juan Solivera Vela ,&nbsp;Aldo Costa ,&nbsp;Marta Ordóñez-Carmona ,&nbsp;José Alberto Escribano-Mesa ,&nbsp;Carlos Doval-Rosa ,&nbsp;Manuel Ramos-Gómez ,&nbsp;Elisa Roldán-Romero ,&nbsp;Francisco Fernández-Valverde ,&nbsp;Marina Álvarez-Benito ,&nbsp;Maria Eugenia López-Espejo ,&nbsp;Fátima Ramírez-Sánchez ,&nbsp;María Teresa Cáceres-Redondo","doi":"10.1016/j.bas.2025.104915","DOIUrl":"10.1016/j.bas.2025.104915","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104915"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145229526","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":"Best Abstract: Intraventricular Involvement in Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Predictors of Mortality and Long-Term Disability","authors":"Dr. Carlo Bortolotti ,&nbsp;Dr. Gianfranco Vornetti ,&nbsp;Caterina Tonon (Prof) ,&nbsp;Dr. Filippo Friso ,&nbsp;Dr. Raffaele Aspide ,&nbsp;Dr. Riccardo Stanzani ,&nbsp;Dr. Alessandra Eleuteri ,&nbsp;Dr. Carmelo Sturiale ,&nbsp;Dr. Massimo Dall’Olio ,&nbsp;Dr. Ciro Princiotta ,&nbsp;Luigi Cirillo (Prof) ,&nbsp;Raffaele Lodi (Prof) ,&nbsp;Dr. Pietro Panni","doi":"10.1016/j.bas.2025.104912","DOIUrl":"10.1016/j.bas.2025.104912","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104912"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145229523","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}