Acta Neurochirurgica最新文献

{"title":"Quantitative evaluation of neuroradiological and morphometric alteration of inferior Fronto-Occipital Fascicle across different brain tumor histotype: an Italian multicentric study","authors":"Roberto Altieri,&nbsp;Andrea Bianconi,&nbsp;Stefano Caneva,&nbsp;Giovanni Cirillo,&nbsp;Fabio Cofano,&nbsp;Sergio Corvino,&nbsp;Oreste de Divitiis,&nbsp;Giuseppe Maria Della Pepa,&nbsp;Ciro De Luca,&nbsp;Pietro Fiaschi,&nbsp;Gianluca Galieri,&nbsp;Diego Garbossa,&nbsp;Giuseppe La Rocca,&nbsp;Salvatore Marino,&nbsp;Edoardo Mazzucchi,&nbsp;Grazia Menna,&nbsp;Antonio Mezzogiorno,&nbsp;Alberto Morello,&nbsp;Alessandro Olivi,&nbsp;Michele Papa,&nbsp;Daniela Pacella,&nbsp;Rosellina Russo,&nbsp;Giovanni Sabatino,&nbsp;Giovanna Sepe,&nbsp;Assunta Virtuoso,&nbsp;Giovanni Vitale,&nbsp;Rocco Vitale,&nbsp;Gianluigi Zona,&nbsp;Manlio Barbarisi","doi":"10.1007/s00701-025-06488-6","DOIUrl":"10.1007/s00701-025-06488-6","url":null,"abstract":"<div><h3>Background</h3><p>Inferior Fronto-Occipital Fascicle (IFOF) is a multitasking connection bundle essential for communication and high level mentalization. The aim of the present study was to quantitatively assess its radiological-anatomical-morphometric modifications according to different brain tumor histotype.</p><h3>Methods</h3><p>A retrospective multicentric Italian study was conducted. IFOF reconstructions were calculated for both hemispheres for each patient diagnosed with Glioblastoma (GBM), Low Grade Glioma (LGG), Brain Metastasis and Meningioma using Elements Fibertracking software (Brainlab AG). A 3D object of each fascicle was evaluated for volume, average fractional anisotropy (FA) and length. The cerebral healthy hemisphere was compared to the pathological contralateral in different tumor histotype.</p><h3>Results</h3><p>1294 patients were evaluated. 156 met the inclusion criteria. We found a significant difference between healthy hemisphere and the contralateral for IFOF mean length and volume (<i>p</i>-value &lt; 0.001). Considering GBM subgroup, Student’s t-test confirmed the results. In LGG subgroup, there was significant difference between the 2 hemispheres for IFOF mean length, mean FA and volume (respectively <i>p</i>-value 0.011; <i>p</i>-value 0.021, <i>p</i>-value &lt; 0.001). In patients affected by brain metastasis (18) Student’s t-test showed a significant difference for FA and volume (<i>p</i>-value 0.003 and 0.02 respectively). No differences were found in patients affected by meningiomas.</p><h3>Conclusions</h3><p>The careful preoperative neuroradiological evaluation of the brain-tumor interface is indispensable to plan a tailored surgical strategy and perform a safe and effective surgical technique. It depends on the tumor histology and pattern of growth. GBM have a mixed component, with the solid enhancing nodule which accounts for IFOF displacement and the peritumoral area which accounts for an infiltrative/destructive effect on the fascicle. LGG determine a prevalent infiltrative pattern. Metastases determine an IFOF dislocation due to peritumoral oedema. Meningiomas do not impact on WM anatomy.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06488-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuronavigation-guided Judet screw technique for C2 pedicle fractures: how I do it","authors":"Giuseppe Maria Vincenzo Barbagallo,&nbsp;Francesco Certo,&nbsp;Carmelo Vitaliti,&nbsp;Giulio Bonomo","doi":"10.1007/s00701-025-06476-w","DOIUrl":"10.1007/s00701-025-06476-w","url":null,"abstract":"<div><h3>Background</h3><p>Atypical Hangman’s fractures may involve bilateral C2 pedicle fractures. Surgical fixation is often required to prevent instability and neurological impairment. The Judet technique, involving transpedicular screw fixation, offers a targeted approach to stabilize C2 pedicle fractures while preserving cervical motion.</p><h3>Method</h3><p>This article presents a neuronavigation-guided modification of the Judet technique for C2 pedicle screw placement. Advanced intraoperative computed tomography (CT) imaging, virtual trajectory planning and intraoperative navigation guidance provide surgical precision and patient safety.</p><h3>Conclusion</h3><p>Neuronavigation can improve the classical Judet technique, enhancing clinical safety and accuracy in fixation of C2 pedicle fractures. This minimally invasive/mini-open approach preserves C1-C2 mobility and reduces complications.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06476-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal neuromonitoring in the nordic countries: experiences and attitudes – a multi-institutional survey","authors":"Anna Søgaard Magnussen,&nbsp;Markus Harboe Olsen,&nbsp;Anders Rosendal Korshøj,&nbsp;Tiit Mathiesen,&nbsp;Axel Forsse,&nbsp;Carsten Reidies Bjarkam,&nbsp;On behalf of the Danish Neurointensive Care Monitoring Consortium","doi":"10.1007/s00701-025-06479-7","DOIUrl":"10.1007/s00701-025-06479-7","url":null,"abstract":"<div><h3>Background</h3><p>Multimodal neuromonitoring (MMM) aids early detection of secondary brain injury in neurointensive care and facilitates research in pathophysiologic mechanisms of the injured brain. Invasive ICP monitoring has been the gold standard for decades, however additional methods exist (aMMM). It was hypothesized that local practices regarding aMMM vary considerably and that inter-and intracenter consensus is low. The survey aimed to investigate this hypothesis including the knowledge, attitudes towards, and use of aMMM in the neurointensive care setting in the Nordic countries.</p><h3>Method</h3><p>The survey was distributed amongst 54 neurosurgical trainees at a Nordic neurosurgery training course and supplemented with 16 center-appointed neuromonitoring experts representing 16 of the 19 neurosurgical centers in the Nordic countries (Norway, Sweden, Denmark, and Finland).</p><h3>Results</h3><p>The response rate was 100% amongst the training course attendents, as well as the center-appointed experts with a total of 70 respondents. The experts covered 16/19 Nordic centers. In-center disagreement was high concerning the use of aMMM methods. In patients with traumatic brain injury, subarachnoid hemorrhage, or other acute brain injuries 50% of the appointed experts stated transcranial Doppler ultrasound (TCD) to be used in most cases in their ICU, and an additional 25% for selected cases. Most appointed experts agreed on electroencephalography (EEG) for selected cases 63%, but only 19% for most cases. Routine use of Invasive brain tissue oxygenation (PbtO₂) was stated by 25–63% and cerebral microdialysis (CMD) by 19–38%. The main perceived concerns with aMMM methods were the usefulness for outcome-changing interventions (43%) and financial issues (19%). Most respondents (67%) believed automated combined analysis of aMMM to be a likely future scenario.</p><h3>Conclusion</h3><p>There was a remarkable variation in the reported use of aMMM among Nordic neurosurgical centers, indicating an extensive lack of consensus on need and utility. Surprisingly routine use of TCD was stated by 75%, presumably for routine monitoring of SAH patients, whereas CMD was mostly considered a research tool. Interestingly, junior staff and appointed experts disagreed on intended local routines, indicating that application of aMMM was more governed organically and by case than on explicit guidelines or that uniform management was not prioritized.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06479-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompressive craniectomy in aneurysmal subarachnoid hemorrhage: can favorable outcome be achieved?","authors":"Teodor Svedung Wettervik,&nbsp;Alba Corell,&nbsp;Merete Sunila,&nbsp;Per Enblad,&nbsp;Fartein Velle,&nbsp;Peter Lindvall,&nbsp;Lars Kihlström Burenstam Linder,&nbsp;Bjartur Sæmundsson,&nbsp;Alexander Fletcher-Sandersjöö,&nbsp;Klas Holmgren","doi":"10.1007/s00701-025-06485-9","DOIUrl":"10.1007/s00701-025-06485-9","url":null,"abstract":"<div><h3>Background</h3><p>Decompressive craniectomy (DC) is a last-tier treatment for managing refractory intracranial hypertension in patients with aneurysmal subarachnoid hemorrhage (aSAH), though concerns persist about whether it primarily prolongs survival in a state of severe disability. This study investigated patient characteristics, surgical indications, complications, and outcomes following DC in aSAH.</p><h3>Methods</h3><p>In this Swedish, retrospective multi-center study, 123 aSAH patients treated with DC between 2008–2022 were included. Data collection included demographic details, aSAH characteristics, injury severity, DC indication, complications, and outcome at roughly six months post-DC (modified Rankin scale [mRS]) dichotomized as survival vs. mortality (0–5 vs. 6) and favorable vs. unfavorable (0–3 vs. 4–6).</p><h3>Results</h3><p>The median age was 53 years and 66% were females. Two thirds presented with a WFNS grade 4–5 and 83% with a Fisher grade 4 hemorrhage. Most aneurysms were located at the middle cerebral artery (65%) and treated with clip ligation (59%). DC significantly reduced midline shift from 9 to 2 mm and obliteration rates of basal cisterns from 95 to 22% (<i>p</i> &lt; 0.05). Reoperation for hematomas or extension of the DC were rare (&lt; 5%). At follow-up, 20% were deceased, while 33% had recovered favorably. In univariate logistic regressions, younger age was associated with favorable outcome and reduced mortality. Other patient demographics, injury severity, and factors related to the DC surgery lacked association with outcome.</p><h3>Conclusions</h3><p>aSAH patients treated with DC presented with severe primary brain injuries and signs of intracranial hypertension. DC resulted in radiological improvements regarding mass effect and a low rate of postoperative complications. Although the results were based on a selected population of aSAH patients, an encouraging rate of favorable outcome was found, particularly among younger patients. However, the absence of additional outcome predictors underscores the ongoing challenges in improving patient selection for DC in aSAH.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06485-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143594773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Middle meningeal artery embolization and subdural evacuating port system placement for chronic subdural hematomas: how I do it","authors":"Ryan Gensler,&nbsp;Clare Grady,&nbsp;Gregory F. Keating,&nbsp;Ehsan Dowlati,&nbsp;Daniel R. Felbaum","doi":"10.1007/s00701-025-06483-x","DOIUrl":"10.1007/s00701-025-06483-x","url":null,"abstract":"<div><h3>Background</h3><p>Chronic subdural hematoma (cSDH) is a common neurosurgical pathology causing significant morbidity and mortality, yet optimal management and intervention remains controversial.</p><h3>Methods</h3><p>We describe embolization of the middle meningeal artery (MMA) and placement of subdural evacuating port systems (SEPS) by a dual trained open and endovascular neurosurgeon. Both procedures are done in sequence in the interventional radiology suite, and real time radiographic results are demonstrable with Xper-CT.</p><h3>Conclusions</h3><p>MMA Embolization followed by evacuation of cSDH with a SEPS is a valuable strategy to mitigate perioperative risk factors and patient comorbidities, through a minimally invasive evacuation with subsequent embolization minimizing recurrence.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06483-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143583409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antisecretory factor for treatment of peritumoral edema in glioblastoma patients","authors":"Louise Carstam,&nbsp;Tomás Gómez Vecchio,&nbsp;Monika Lyczak,&nbsp;Hanna Åberg,&nbsp;Asgeir S. Jakola,&nbsp;Eva Jennische,&nbsp;Stefan Lange,&nbsp;Kliment Gatzinsky","doi":"10.1007/s00701-025-06481-z","DOIUrl":"10.1007/s00701-025-06481-z","url":null,"abstract":"<div><h3>Purpose</h3><p>Glioblastoma (GBM) is an aggressive brain tumor often accompanied by a vasogenic peritumoral edema, which contributes to symptoms both at diagnosis and during later stages of the disease. Previous studies have suggested effectiveness of the endogenous protein, Antisecretory Factor (AF), in reducing the intracranial pressure in cytotoxic brain edema after trauma. Interestingly, AF also seems to carry antineoplastic effects in experimental GBM models. This study investigated whether AF reduces peritumoral edema in GBM patients. As a secondary aim, we assessed potential effects on tumor progression by AF.</p><h3>Methods</h3><p>Fifteen newly diagnosed GBM patients were treated for 7 days preoperatively with AF in addition to standard of care (SOC) treatment with corticosteroids. The change in edema volume was assessed volumetrically using T2/FLAIR weighted MRI and compared to a control group of 10 GBM patients receiving SOC only.</p><h3>Results</h3><p>At baseline the mean tumor volume for the entire cohort was 35.7 cm3 with a mean edema of 62.2 cm3. There was no significant difference in edema volume change between the AF treated patients, who demonstrated a mean edema reduction of 7.1cm3 (95%CI -5.4–19.6), and the controls, 11.3cm3 (95%CI -0.8–23.5), <i>p</i> = 0.61. No difference was observed in tumor volume change between the two groups, <i>p</i> = 0.79. No adverse treatment effects were noted.</p><h3>Conclusion</h3><p>Treatment with AF in addition to SOC does not seem to reduce the peritumoral edema in GBM patients. The treatment was well tolerated. The lack of edema-reducing effect may be related to the different pathophysiological properties of vasogenic and cytotoxic edema.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06481-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143570916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral microdialysis values in healthy brain tissue – a scoping review","authors":"Ingrid Løchen Granerud,&nbsp;Maria Louise Fabritius,&nbsp;Helene Ravnholt Jensen,&nbsp;Kirsten Møller,&nbsp;Martin Kryspin Sørensen","doi":"10.1007/s00701-025-06424-8","DOIUrl":"10.1007/s00701-025-06424-8","url":null,"abstract":"<div><h3>Background</h3><p>Intracerebral microdialysis is an advanced method to guide clinicians during intensive care of patients with severe acute brain injury. Using intracerebral microdialysis, markers of brain metabolism and homeostasis can be analysed. Currently, trends are considered more important in clinical decision-making than absolute values. Establishing absolute reference values in healthy brain tissue may facilitate an earlier detection of abnormal brain tissue metabolism and provide better decision support for clinicians. However, the current evidence on normal values in the uninjured human brain has not previously been summarized. The aim of this study was to summarise the literature regarding microdialysate concentrations of common markers of brain energy metabolism (glucose, lactate, pyruvate, glutamate, and glycerol) in vivo in healthy brain tissue of humans and gyrencephalic animals.</p><h3>Method</h3><p>MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science were searched for published studies that report values of microdialysis in healthy brain tissue. In order to identify unpublished studies, we searched ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP), and EU Clinical Trials Register. Study quality was evaluated using a pre-specified protocol.</p><h3>Result</h3><p>Out of 3257 studies identified, 39 studies were included. Six of these studies were in humans (total <i>n</i> = 54), 26 in pigs/swine (<i>n</i> = 432), two on monkeys (<i>n</i> = 10), one in sheep (<i>n</i> = 15), and one in dogs (<i>n</i> = 10). We found a high degree of clinical and methodological heterogeneity in both human and gyrencephalic animal studies.</p><h3>Conclusion</h3><p>This scoping review identified studies that applied microdialysis to measure common biomarkers in healthy brain tissue. The clinical and methodological heterogeneity between the measured values was substantial, limiting any conclusions. Furthermore, the quality of several human studies was moderate at best. Methodologically comparable studies are warranted to establish reference values for markers of brain energy metabolism using intracerebral microdialysate.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06424-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143570945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burr hole evacuation of chronic subdural hematoma in general versus local anesthesia: a systematic review and meta-analysis","authors":"Clara F. Weber,&nbsp;Kiarash Ferdowssian,&nbsp;Nils Hecht,&nbsp;Peter Vajkoczy,&nbsp;Lars Wessels,&nbsp;Robert Mertens","doi":"10.1007/s00701-025-06475-x","DOIUrl":"10.1007/s00701-025-06475-x","url":null,"abstract":"<div><h3>Purpose</h3><p>Chronic subdural hematoma (cSDH) is a highly prevalent condition that frequently requires surgical evacuation. This is typically achieved through burr hole evacuation, which can be performed under either local anesthesia (LA) or general anesthesia (GA). In the present study, we provide a systematic review and meta-analysis to study and compare the safety and efficacy of cSDH evacuation in LA and GA.</p><h3>Methods</h3><p>Following the PRISMA guidelines, we screened four databases for studies that compared postoperative outcomes after burr hole evacuation of cSDH in LA versus GA. Baseline characteristics and postoperative outcome data were collected, and risk ratios were calculated for each study as well as pooled across records. Random effect models were applied to continuous data points. Bias was assessed using the MINORS tool.</p><h3>Results</h3><p>We identified 22 eligible studies covering 3917 patients in total. LA was associated with decreased risk for complications (p &lt; 0.001), shorter surgery duration (p &lt; 0.001) and hospital stay (p &lt; 0.001). There was no statistically significant association with recurrence rates, postoperative seizure or occurrence of pneumocephalus. In a subanalysis including only data from studies utilizing subdural drainage, results remained largely similar with LA proving advantageous in terms of shorter surgery duration (p &lt; 0.001) and hospital stay (p &lt; 0.001).</p><h3>Conclusion</h3><p>LA may serve as a safe alternative to GA for cSDH surgery, associated with fewer postoperative complications and providing benefits regarding shorter hospital stay and surgery duration.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06475-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental fatigue and cognitive functioning in patients presenting with non-enhancing gliomas","authors":"Alice Neimantaite,&nbsp;Tomás Gómez Vecchio,&nbsp;Isabelle Rydén,&nbsp;Dima Harba,&nbsp;Asgeir S. Jakola,&nbsp;Anja Smits","doi":"10.1007/s00701-025-06434-6","DOIUrl":"10.1007/s00701-025-06434-6","url":null,"abstract":"<div><h3>Purpose</h3><p>Patients with diffuse lower-grade gliomas (LGG) often suffer from mental fatigue. In healthy subjects, mental fatigue has a negative impact on cognitive functioning. This relation may be more complex in LGG, where tumor localization and growth rate also impact brain function. Our aim was to investigate how self- and observer-reported variables of mental fatigue and cognitive functioning were connected before tumor treatment.</p><h3>Methods</h3><p>Consecutive patients scheduled for surgery due to presumed LGG were screened (<i>n</i> = 157). LGG was presumed if the mass was suggestive of diffuse glioma, but without significant contrast enhancement. Isocitrate dehydrogenase (IDH)-mutated WHO grade 2 or 3 gliomas (the LGG group) were analyzed separately. We included 101 patients in the entire cohort, whereas 71 patients constituted the LGG group. Patient data included: (1) self-reported assessments of mental fatigue and cognitive functioning, (2) neuropsychological test performances, and (3) clinical/demographic characteristics. Spearman's partial correlations were calculated between the variables and visualized in a correlation network.</p><h3>Results</h3><p>Cognitive impairment was self-reported by 50% of the entire cohort and 45% of the LGG group, while observer-evaluated testing showed cognitive impairment in 40% and 34% of the cases respectively. Self-reported assessments showed no correlations (≥ 0.3 or ≤-0.3) with neuropsychological test performances. A consistent correlation was seen between self-reported mental fatigue and self-reported cognitive functioning (entire cohort: rho=-0.66, LGG group: -0.64).</p><h3>Conclusion</h3><p>Our results highlight the complexity of evaluating symptoms of mental fatigue and cognitive functioning even prior to surgery. Self-reports and neuropsychological testing were weakly correlated, hence these should be handled complimentary.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06434-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143570917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Knosp enough? A novel classification for Acromegaly: a retrospective analysis of cure rates and outcome predictors in a large tertiary centre","authors":"Feras Fayez,&nbsp;Ahmed Abougamil,&nbsp;Francesca Vitulli,&nbsp;James Knight,&nbsp;Christoforos Syrris,&nbsp;Oktay Genel,&nbsp;Jonathan Shapey,&nbsp;Eleni Maratos,&nbsp;Nicholas Thomas,&nbsp;Sinan Barazi","doi":"10.1007/s00701-025-06477-9","DOIUrl":"10.1007/s00701-025-06477-9","url":null,"abstract":"<div><h3>Purpose</h3><p>This study evaluates surgical outcomes for acromegaly at King’s College Hospital(2012–2022), focusing on predictive factors for surgical cure. A novel radiological metric, the MI Ratio, is introduced to enhance the prediction of clinical remission post-surgery, providing a more accurate prognosis and informing treatment planning.</p><h3>Methods</h3><p>This single-centre cohort study involved a retrospective analysis of prospectively collected data from a UK tertiary referral centre. Included were patients with histologically proven somatotroph tumours who underwent endoscopic trans-sphenoidal surgery (TSS) between 2012 and 2022. Exclusions were made for incomplete data or lost follow-up. Patient demographics, tumour characteristics, radiological parameters, and biochemical markers were analysed. The MI Ratio was defined as the distance from the midline to the lateral maximum of a tumour, divided by the distance between the two cavernous carotid arteries on coronal MRI.</p><h3>Results</h3><p>Out of 157 patients, 150 met the inclusion criteria. Using the 2018 consensus OGTT nadir &lt; 0.40 ng/mL, microadenomas had a higher surgical cure rate (72%) compared to macroadenomas (48%), with an overall cure rate of 53%. Significant predictors of surgical cure included the MI Ratio (<i>p</i> &lt; 0.001), microadenomas (<i>p</i> = 0.022), Knosp score &lt; 2 (<i>p</i> = 0.012), immediate post-operative GH level (<i>p</i> = 0.016), and patient gender (<i>p</i> = 0.005). Pre-operative medical management did not significantly impact surgical remission (<i>p</i> = 0.19), while pre-operative GH level approached significance (<i>p</i> = 0.06). CV between operators for MI was &lt; 5% indicating minimal Interoperator variability.</p><h3>Conclusions</h3><p>This study is the first to describe the MI Ratio, demonstrating its utility in predicting surgical remission in acromegaly patients. A combination of radiological features, demographics, and hormone profiles can more accurately identify patients less likely to achieve surgical cure.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06477-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143571176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}