Brain & spine最新文献

{"title":"BOOTStrap-SCI: Beyond One option of treatment for spinal trauma and spinal cord injury: Consensus-based stratified protocols for pre-hospital care and emergency room (part I)","authors":"Nicolò Marchesini ,&nbsp;Andreas K. Demetriades ,&nbsp;Oscar Alves ,&nbsp;Riya Mandar Dange ,&nbsp;Harold Mauricio Choco ,&nbsp;Edinson Dussan Lozada ,&nbsp;Dumar Javier Figueredo Sanabria ,&nbsp;Angélica Gamboa ,&nbsp;Luz Llined Mendoza Victoria ,&nbsp;Enoc Noscue Montealegre ,&nbsp;Jonathan A. Pardo Carranza ,&nbsp;Jonathan Velásquez Quintero ,&nbsp;Andrès M. Rubiano ,&nbsp;the BOOTStraP-SCI Study Group","doi":"10.1016/j.bas.2025.104251","DOIUrl":"10.1016/j.bas.2025.104251","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal trauma (STx), with or without spinal cord injury (SCI), represents a significant global health burden, particularly in low- and middle-income countries (LMICs). Existing guidelines often rely on tools and resources that are not always universally available, especially in less resourced settings, contributing to disparities in care and outcomes. A pragmatic, resource-adapted approach may help optimize management in these contexts.</div></div><div><h3>Research question</h3><div>This study aimed to develop resource-adapted protocols for pre-hospital and emergency room management of STx and <span>SCI</span>, addressing challenges specific to LMICs while supported by clinical evidence and expert based practices.</div></div><div><h3>Material and methods</h3><div>A multidisciplinary Delphi consensus combined international evidence-based guidelines with expert opinions. Iterative discussions and voting by healthcare providers from LMICs and high-income countries (HICs) ensured the development of context-sensitive protocols. These were tailored to varying levels of training, resource availability, and healthcare infrastructure.</div></div><div><h3>Results</h3><div>The resulting protocols address key areas of pre-hospital and emergency management, including initial resuscitation, immobilization, clinical interventions, and timely referral. These protocols emphasize adaptability, providing structured plus flexible guidance for optimizing care according to specific contexts from low to high resourced clinical settings.</div></div><div><h3>Discussion and conclusion</h3><div>The proposed protocols are not intended as gold-standard guidelines but as adaptable frameworks to guide management of STx/SCI in contexts with different availability of resources. By addressing disparities in resource availability and clinical competencies, they can serve as a foundation for local adaptations and improvements in care. Future research should evaluate their implementation and impact on outcomes.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104251"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143821499","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":"Diagnostic and prognostic value of navigated transcranial magnetic stimulation to assess motor function in patients with acute traumatic spinal cord injury","authors":"Maximilian Schwendner ,&nbsp;Marianne Kanaris ,&nbsp;Anthony M. DiGiorgio ,&nbsp;Michael C. Huang ,&nbsp;Geoffrey T. Manley ,&nbsp;Phiroz E. Tarapore","doi":"10.1016/j.bas.2025.104229","DOIUrl":"10.1016/j.bas.2025.104229","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic spinal cord injuries (SCI) represent a profoundly life-altering diagnosis.</div></div><div><h3>Research question</h3><div>The aim of this study was to evaluate the diagnostic and prognostic value of navigated transcranial magnetic stimulation (nTMS) in assessing motor function in the management of patients with acute SCI.</div></div><div><h3>Material and methods</h3><div>nTMS motor mapping of both upper extremities (UE) and lower extremities (LE) was performed in patients suffering from acute traumatic SCI. Data from intraoperative neuromonitoring (IONM) and patient outcomes, including American Spinal Injury Association Impairment Scale (AISA) scores, were analyzed.</div></div><div><h3>Results</h3><div>The patients had a mean age of 68.9 ± 15.6 years (range: 28–94 years). Preoperatively, 7 patients (35.0%) were classified as AISA A or B, and 13 (65.0%) were classified as AISA C or D. At follow-up, 5 patients (25.0%) had improved.</div><div>In all patients motor evoked potentials (MEPs) were elicited. MEPs of UE muscles were observed in 38 (61.3%) muscles in IONM and 41 (66.1%) muscles in TMS. MEPs of LE muscles were observed in 5 (19.2%) and 7 (26.9%) muscles, respectively. e</div><div>Combining the results of IONM and nTMS, a sensitivity of 0.852 and a specificity of 0.889 for motor function of the tested muscle at follow-up was achieved for upper extremity muscles. For lower extremity muscles, a sensitivity of 0.571 and a specificity of 1.00 was achieved.</div></div><div><h3>Discussion and conclusion</h3><div>nTMS in patients with acute SCI provides an objective assessment of motor system integrity. Despite a relatively low sensitivity, potentially due to decreased excitability, this technique exhibited excellent specificity in predicting short-term and long-term motor outcomes.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104229"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619254","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":"Multidimensional outcome after endovascular or microsurgical occlusion of ruptured intracranial aneurysms – Comparative analysis of a prospective Swiss multicenter study","authors":"Vincens Kälin ,&nbsp;Martin N. Stienen ,&nbsp;Olivia Zindel-Geisseler ,&nbsp;Noemi Dannecker ,&nbsp;Yannick Rothacher ,&nbsp;Ladina Schlosser ,&nbsp;Julia Velz ,&nbsp;Martina Sebök ,&nbsp;Noemi Eggenberger ,&nbsp;Adrien May ,&nbsp;Philippe Bijlenga ,&nbsp;Ursula Guerra-Lopez ,&nbsp;Rodolfo Maduri ,&nbsp;Daniele Starnoni ,&nbsp;Valérie Beaud ,&nbsp;Alessio Chiappini ,&nbsp;Thomas Robert ,&nbsp;Sara Bonasia ,&nbsp;Stefania Rossi ,&nbsp;Johannes Goldberg ,&nbsp;Luca Regli","doi":"10.1016/j.bas.2025.104262","DOIUrl":"10.1016/j.bas.2025.104262","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite advances in cerebral aneurysm treatment, information on detailed outcomes remains limited. We compared complications and multidimensional outcomes in alert aneurysmal subarachnoid hemorrhage (aSAH) patients (GCS ≥13) who received clipping or coiling after individualized decisions were made through multidisciplinary board discussions.</div></div><div><h3>Research question</h3><div>Are there significant differences in multidimensional outcomes between clipping and coiling treatments for alert aSAH patients when treatment selection is individualized?</div></div><div><h3>Material and methods</h3><div>Within the prospective MoCA-DCI study (ClinicalTrials.gov identifier: NCT03032471), patients with a GCS of 13–15 72h post-aSAH in six neurovascular centers underwent neuropsychological (Montreal Cognitive Assessment; MoCA), neurological (National Institutes of Health Stroke Scale; NIHSS), headache (visual analog scale; VAS), disability (modified Rankin Scale; mRS) and health-related quality of life (EuroQol Five Dimensions; EQ5D) assessments within 72h, 14 days and three months after aSAH. We compared these multidimensional outcomes and complications for clipped and coiled patients.</div></div><div><h3>Results</h3><div>Of 126 patients (mean age 53.8 years; 63.9 % female), 84 were coiled and 42 clipped. MoCA scores for clipped vs coiled patients were 23(7) vs 23(8; p = 0.250), 25(8) vs 28(5; p = 0.346), and 27(4) vs 28(5; p = 0.481). Normal cognition (MoCA ≥26) was achieved within 72h by 28.6 % of coiled and 40.5 % of clipped patients (p = 0.179). Complication rates were similar, though surgical patients had higher intraprocedural rupture rates (p = 0.027). Clipped patients reported higher headaches at three months (p = 0.013), while NIHSS, mRS and EQ5D showed no differences.</div></div><div><h3>Discussion and conclusion</h3><div>After interdisciplinary selection of the most appropriate treatment, similar favorable outcomes can be achieved in alert aSAH patients.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104262"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906271","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 transformative power of telemedicine in delivering effective neurosurgical care in low and middle-income countries: A review","authors":"Pearl Ohenewaa Tenkorang ,&nbsp;Wireko Andrew Awuah ,&nbsp;Krishitha Meenu Mannan ,&nbsp;Subham Roy ,&nbsp;Princess Afia Nkrumah Boateng ,&nbsp;Olivia Asiedu ,&nbsp;Marjidah Tahiru ,&nbsp;Arjun Ahluwalia ,&nbsp;Nana Osei Owusu Bediako ,&nbsp;Kwadwo Darko","doi":"10.1016/j.bas.2025.104269","DOIUrl":"10.1016/j.bas.2025.104269","url":null,"abstract":"<div><h3>Introduction</h3><div>Telemedicine has been integrated into healthcare systems for over two decades, with the COVID-19 pandemic accelerating its adoption across various medical fields, including neurosurgery. Low- and middle-income countries (LMICs) face significant challenges such as a shortage of neurosurgeons and inadequate healthcare infrastructure. Teleneurosurgery offers a crucial solution to these challenges, improving access to specialized care and enhancing patient outcomes in resource-constrained settings.</div></div><div><h3>Research Question</h3><div>How has teleneurosurgery been used to enhance access to specialized neurological care and improve patient outcomes in low- and middle-income countries?</div></div><div><h3>Methods</h3><div>This narrative review employed a comprehensive search strategy to assess the role of telemedicine in neurosurgery within Low- and middle-income countries. Literature was searched across PubMed, EMBASE, and Scopus, using specific search terms related to teleneurosurgery, virtual consultations, and remote monitoring. Various study designs, including clinical trials, cohort studies, and case reports, were included, while isolated abstracts and unpublished studies were excluded. The review synthesizes the evidence to inform best practices in resource-limited environments.</div></div><div><h3>Results</h3><div>Through remote consultations, pre-operative assessments and post-operative follow-up, telemedicine has become an essential tool to improve patient outcomes and increase access to neurosurgical care, particularly in underserved regions. The ability to conduct virtual assessments and provide specialized care remotely reduces the need for patients to travel long distances, thereby reducing the burden on already strained healthcare systems.</div></div><div><h3>Discussion and Conclusion</h3><div>Despite its growing adoption, low- and middle-income countries continue to face challenges such as limited internet connectivity, regulatory barriers, and infrastructure deficiencies. However, mobile health solutions, international collaborations, and capacity-building initiatives are helping to overcome these obstacles. The future of teleneurosurgery in low- and middle-income countries is promising, but sustained investment in technology, training, and regulatory frameworks is essential to maximize its impact and address disparities in neurosurgical care.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104269"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906276","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":"Optimizing microvascular decompression for trigeminal Neuralgia: Addressing vertebrobasilar ectasia challenges – A technical note","authors":"Pavlina Lenga ,&nbsp;Carola Wieckhusen ,&nbsp;Mohammad Mehdi Hajiabadi ,&nbsp;Andreas Unterberg ,&nbsp;Sandro M. Krieg ,&nbsp;Rezvan Ahmadi","doi":"10.1016/j.bas.2025.104264","DOIUrl":"10.1016/j.bas.2025.104264","url":null,"abstract":"<div><h3>Introduction</h3><div>Trigeminal neuralgia (TN) can be due vertebrobasilar ectasia (VBE), where elongated, tortuous arteries compress the trigeminal nerve, making surgical management challenging.</div></div><div><h3>Research question</h3><div>Does a refined microvascular decompression (MVD) technique using a “Teflon cloud” interposition offer sustained symptom relief and medication discontinuation in VBE-induced TN?</div></div><div><h3>Materials and methods</h3><div>Three patients with VBE-induced TN were treated between 2017 and 2024. Diagnosis was confirmed by MRI/MRA. MVD with a “Teflon cloud” was performed to cushion the nerve without extensive arterial manipulation. Postoperative outcomes were tracked over an 8-month follow-up.</div></div><div><h3>Results</h3><div>All patients showed immediate, complete relief of TN symptoms, with no recurrences. They discontinued TN-related medications within three months, and no significant complications occurred.</div></div><div><h3>Discussion and conclusion</h3><div>These findings suggest that interposition-based MVD using a Teflon cloud effectively addresses TN in the context of VBE by providing stable nerve decompression and minimizing vascular manipulation. A refined MVD with a “Teflon cloud” interposition provides safe, sustained relief for VBE-induced TN, warranting further investigation in larger patient cohorts.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104264"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143904128","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":"A core outcome set for cranioplasty following stroke or traumatic brain injury - The COAST study","authors":"H. Mee ,&nbsp;T.K. Korhonen ,&nbsp;A.M. Castaño-Leon ,&nbsp;A. Adeleye ,&nbsp;J. Allanson ,&nbsp;F. Anwar ,&nbsp;I.D. Bhagavatula ,&nbsp;K. Bond ,&nbsp;C. Clement ,&nbsp;A.M. Rubiano ,&nbsp;K. Grieve ,&nbsp;G. Hawryluk ,&nbsp;A. Helmy ,&nbsp;S. Honeybul ,&nbsp;C. Iaccarino ,&nbsp;A. Lagares ,&nbsp;H. Marcus ,&nbsp;N. Marklund ,&nbsp;S. Muehlschlegel ,&nbsp;N. Owen ,&nbsp;A. Kolias","doi":"10.1016/j.bas.2025.104288","DOIUrl":"10.1016/j.bas.2025.104288","url":null,"abstract":"<div><h3>Introduction</h3><div>There is substantial heterogeneity in the reporting of outcomes in the global cranioplasty literature. This study aimed to establish a core outcome set (COS) for cranioplasty after decompressive craniectomy for stroke or traumatic brain injury.</div></div><div><h3>Methodology</h3><div>The scope was defined according to the criteria recommended by the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Phase 1 focused on outcome gathering through a systematic review and a qualitative study. Phase 2 focused on consolidation and consensus of outcomes through a two-round Delphi survey and consensus meeting. Participants from the four stakeholder groups (1. patients and/or relatives; 2. Surgeons, 3. physicians (non-surgeons), 4. Nurses, allied health professionals, and researchers) individually scored all outcomes on a 9-point Likert scale. Variables that did not reach the predefined consensus threshold for COS inclusion or exclusion were voted upon at the final consensus meeting.</div></div><div><h3>Results</h3><div>In total, 208 verbatim outcomes were consolidated into 56 domains. A total of 153 participants completed round 1, with 45 additional outcomes suggested for inclusion. Following rationalisation, four were included in round 2. A total of 109/153 participants (71 %) from 16 countries completed Round 2 and re-scored all 60 outcomes (56 original + 4 additional). Nine outcomes were voted in, and 12 were excluded from the Delphi. The remaining 39 were discussed at a consensus meeting with 11 voted in. The final COS included 20 outcomes (12 + 8) across four domains: life impact, pathophysiological manifestations, resource use/economic impact, and mortality.</div></div><div><h3>Conclusion</h3><div>COAST COS covers key cranioplasty outcomes, as assessed by international stakeholders, including surgical, medical, rehabilitation, and nursing professionals, as well as patients and their relatives. Future implementation will aid in the standardisation of outcomes and facilitate the development of cranioplasty-specific outcome measures, aiding between-study comparisons and improving the relevance of trial findings to healthcare professionals and patients.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104288"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144270327","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":"PD-L1 expression in PitNETs: Correlations with the 2022 WHO classification","authors":"Ethan Harel ,&nbsp;Ekkehard Hewer ,&nbsp;Stefano La Rosa ,&nbsp;Jean Philippe Brouland ,&nbsp;Nelly Pitteloud ,&nbsp;Federico Santoni ,&nbsp;Maxime Brunner ,&nbsp;Roy Thomas Daniel ,&nbsp;Mahmoud Messerer ,&nbsp;Giulia Cossu","doi":"10.1016/j.bas.2024.104171","DOIUrl":"10.1016/j.bas.2024.104171","url":null,"abstract":"<div><h3>Introduction</h3><div><u>and research question</u>: Prognostic factors to predict the behavior of pituitary neuroendocrine tumors (PitNET) are scarce. PD-L1 expression was associated with prognosis in other neuroendocrine neoplasms and we analyzed PD-L1 expression in PitNET, according to the 2022 WHO classification.</div></div><div><h3>Material and methods</h3><div>A retrospective analysis was performed. Immunohistochemistry was used to define PD-L1 expression, which was quantified as TPS (tumor proportion score). The primary outcome was to assess the correlation between PD-L1 expression and transcription factors (TF), namely T-pit, Pit-1, SF-1 and GATA-3. As secondary outcomes, we evaluated the association between PD-L1 expression and proliferation indexes.</div></div><div><h3>Results</h3><div>Eighty-eight patients were included. The largest group belonged to the SF-1-lineage (48%), followed by tumors of the Pit-1 lineage (32%) and T-pit lineage (17%). PD-L1 expression was associated with Pit-1 expression (p &lt; 0.001) and with the somatotroph, lactotroph and mammosomatotroph subgroups. A TPS ⩾35% showed a 100% sensitivity for the mammosomatotroph subtype, while the optimal cut-off point was 20% for somatotroph and 15% for lactotroph tumors. PD-L1 expression was negatively associated with SF-1 and GATA3 expression(p &lt; 0.001), with an optimal cut-point ≤5%. No association was found between PD-L1 expression and immunohistochemical proliferative factors but PD-L1 expression was associated with female sex and a younger age at diagnosis.</div></div><div><h3>Conclusion</h3><div>PD-L1 expression was associated with PIT-1 lineage, while it was downregulated in SF-1-lineage tumors. No correlation was found with proliferative factors. The role of PD-L1 expression in determining the biological behavior of PitNET remains debated and larger studies are necessary to further confirm these findings.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104171"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11751414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143026073","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":"Additional dorsal interspinous stabilisation has no advantage after decompression of degenerative lumbar spinal stenosis","authors":"Josephin Cebulla ,&nbsp;Lukas P. Staub ,&nbsp;Thomas Barz","doi":"10.1016/j.bas.2024.104166","DOIUrl":"10.1016/j.bas.2024.104166","url":null,"abstract":"<div><h3>Introduction</h3><div>Interspinous devices are an alternative to instrumented fusion for the treatment of lumbar spinal stenosis (LSS) with radiological instability or deformity. The devices claim to improve clinical symptoms by indirect foraminal decompression with fewer complications and similar functional outcomes compared to conventional fusion techniques, and by avoiding a (further) deterioration of the anatomy of the spine while being less invasive than instrumented fusion.</div></div><div><h3>Research question</h3><div>Do interspinous devices provide a benefit in combination with a decompression of degenerative LSS?</div></div><div><h3>Material and methods</h3><div>In this observational study, 117 patients were treated by decompression surgery alone (n = 37), decompression plus instrumented spinal screw fixation and anterior cage support (n = 41) or decompression plus stabilisation with interspinous devices (n = 39). Pelvic tilt, pelvic incidence, lumbar lordosis, and spondylolisthesis were measured on X-ray scans before surgery, 3 and 12 months postoperative. The Oswestry Disability Index, back and leg pain were also assessed. Generalized Estimating Equation regression models were used to determine the relationship between the outcomes and treatment group over time.</div></div><div><h3>Results</h3><div>After interspinous stabilisation surgery the mean pelvic tilt remained at 22.7°, and the difference between the pelvic incidence and lumbar lordosis (PI-LL) remained at 10.5°. In all three groups, the ODI decreased by 14–18 points (p&lt;0.01), and the pain levels decreased by 2.6–3.2 points (p&lt;0.01).</div></div><div><h3>Conclusion</h3><div>We found no scientific evidence to support the use of interspinous devices. The sagittal profile could not be stabilised by this intervention, and no clinical advantage over decompression surgery alone was evident.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104166"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985645","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":"Microsurgical resection of intracranial meningiomas in patients aged 80 years old or more: A systematic review and meta-analysis","authors":"Simon Diaz ,&nbsp;Marc Levivier ,&nbsp;Nicolas Reyns ,&nbsp;Constantin Tuleasca","doi":"10.1016/j.bas.2025.104201","DOIUrl":"10.1016/j.bas.2025.104201","url":null,"abstract":"<div><h3>Introduction</h3><div>The incidence of intracranial meningiomas rises with advancing age, raising the question of whether similar surgical outcomes in morbidity and mortality can be expected compared to younger population. We conducted a systematic review and meta-analysis of research examining microsurgical outcomes in those aged 80 years or older.</div></div><div><h3>Methods</h3><div>Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we reviewed articles published between January 1995 and January 2024, referenced in PubMed or Embase. Inclusion criteria were peer-reviewed clinical studies of series reporting microsurgical resection of intracranial meningiomas in patients aged 80 years or more, written in English. Primary outcome was EOR (extend of resection), classified as tumor total resection versus partial resection. Secondary outcomes were morbidity and mortality.</div></div><div><h3>Results</h3><div>Ten studies reported 690 patients. Total tumor resection was achieved in 88% of cases (range 85–91; I² = 56; p heterogeneity = 0.02; p &lt; 0.01). Tumor partial resection was achieved in 12% (range 9–15; I^2 = 56; p heterogeneity = 0.02 and p &lt; 0.001). Postsurgical intracerebral hemorrhage was encountered in 1% of cases (range 0–2; I^2 = 69; p heterogeneity = &lt; 0.01). Surgical mortality was encountered in 5% of cases (range 3–7; I^2 = 61; p heterogeneity = &lt; 0.01).</div></div><div><h3>Conclusion</h3><div>Current data suggests that achieving high total resection rates, up to 88%, is feasible. The surgical mortality rate was 5%. A key unresolved neurosurgical dilemma is whether to operate on patients over 80 years old. Future studies are essential to assess all relevant risk factors comprehensively.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104201"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143600830","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":"Multiple isolated spinal aneurysms – A rare condition with uncertain treatment strategies: A case report and literature review","authors":"F.M.C. Lioi ,&nbsp;D. Dahlberg ,&nbsp;J. Sundseth ,&nbsp;K.B. Olsen ,&nbsp;H.L. Lilleby ,&nbsp;B. Nedregaard ,&nbsp;M.K.H. Wiedmann","doi":"10.1016/j.bas.2025.104192","DOIUrl":"10.1016/j.bas.2025.104192","url":null,"abstract":"<div><h3>Purpose</h3><div>Isolated spinal aneurysms (iSAs) are rare, with an uncertain natural history and no established treatment guidelines. Multiple iSAs are even more uncommon, complicating treatment decisions.</div></div><div><h3>Methods</h3><div>This study reports a case of a ruptured radiculo-pial artery aneurysm in a patient with multiple iSAs, treated with surgical excision, assisted by intraoperative neurophysiological monitoring (IONM). Further, we review and analyze all previously reported cases of multiple iSAs.</div></div><div><h3>Results</h3><div>A 67-year-old woman with spinal subarachnoid hemorrhage and spinal cord compression due to a ruptured radiculo-pial artery aneurysm was treated surgically. Digital subtraction angiography (DSA) showed three spinal aneurysms. Intraoperative indocyanine green video-angiography (ICG-VA) revealed an aneurysm contributing to the left posterior spinal artery. The aneurysm was excised after proximal inflow occlusion under IONM. The other aneurysms spontaneously regressed, and the patient had a good functional outcome. Through a systematic literature review, we analyzed 13 multiple iSAs including our case, involving 34 aneurysms in total.</div></div><div><h3>Conclusions</h3><div>There is no standardized treatment approach for multiple iSAs. These aneurysms are often fusiform and clustered in contiguous metameric regions. They can be classified into flow-related and wall-weakening aneurysms. Surgery offers definitive treatment for ruptured iSAs and relieves spinal cord compression. Due to the common fusiform shape, parent vessel sacrifice may be necessary, and should include IONM and ICG-VA to minimize complications. Conservative treatment is viable as spontaneous regression often occurs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104192"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101926","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}