Acta Neurochirurgica最新文献

{"title":"Timing of surgery for chronic subdural hematoma in patients with mild to moderate symptoms: a retrospective cohort study","authors":"M. Foppen,&nbsp;K.M. Slot,&nbsp;W.P. Vandertop,&nbsp;D. Verbaan","doi":"10.1007/s00701-025-06552-1","DOIUrl":"10.1007/s00701-025-06552-1","url":null,"abstract":"<div><h3>Background</h3><p>Burr hole drainage is the mainstay of treatment for chronic subdural hematoma (cSDH). However, the impact of the interval between diagnosis and surgery on clinical outcome is unknown. This study investigates whether surgical timing affects outcome in patients with mild to moderate symptoms who do not require immediate surgery.</p><h3>Methods</h3><p>We performed a single center, retrospective cohort study of 330 surgically treated cSDH patients with a Markwalder Grading Scale score of 1–2, at the Amsterdam UMC, between 2012 and 2022. The interval between diagnosis and surgery was measured in hours and dichotomized (surgery within vs. after 24 h). To account for potential confounding by hematoma mass effect, patients were stratified based on midline shift (greater than 10 mm vs &lt; 10 mm). Primary outcomes included reoperation rate, complication rate, 30-day mortality, length of hospital stay and discharge destination. Univariable and multivariable regression analyses were performed for each stratum.</p><h3>Results</h3><p>The mean age of the cohort was 73 years, and 241 (73%) were male. The median time to surgery was 25 h (IQR 15–54). Among the 330 patients, 157 (48%) underwent surgery within 24 h after diagnosis. Patients who received early surgery (&lt; 24 h) had a significantly higher proportion of midline shift &gt; 10 mm compared to those undergoing later surgery (56% vs. 34%, p &lt; 0.001). The use of anticoagulant or antiplatelet therapy did not differ between groups (47% vs 54%, p = 0.27). No significant association was found between surgical timing and any primary outcome across all strata.</p><h3>Conclusion</h3><p>In patients with cSDH presenting with mild to moderately symptoms, the timing of surgery did not affect clinical outcome, particularly as delayed surgery did not result in poorer outcomes. These findings suggest that postponing surgery to daytime hours may be safe in this subgroup. Validation in prospective studies, ideally incorporating functional outcomes, is nevertheless required to confirm these results and guide clinical practice.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06552-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084992","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":"Hemostatic disturbances in traumatic brain injury: from mechanism to management","authors":"Alexander Fletcher-Sandersjöö,&nbsp;Jennifer Sebghati,&nbsp;Eric Peter Thelin","doi":"10.1007/s00701-025-06549-w","DOIUrl":"10.1007/s00701-025-06549-w","url":null,"abstract":"<div><p>Coagulopathy following traumatic brain injury (TBI) is increasingly being recognized as a determinant of hematoma expansion and outcome. Unlike systemic trauma, where coagulopathy is often driven by hemorrhagic shock, TBI appears to induce a unique brain-derived hemostatic response. In this review, we discuss the mechanisms underlying TBI-induced coagulopathy, its diagnostic challenges, and association with hematoma expansion. We further evaluate evidence from randomized trials targeting coagulopathy in TBI, including interventions such as tranexamic acid, plasma, recombinant Factor VIIa, and fibrinogen. While several studies show proof of concept, clinical benefit remains inconsistent, likely due to issues of timing, heterogeneity, and underpowered study design. Moving forward, ultra-early and individualized approaches guided by real-time hemostatic monitoring may offer the most promising path. A better understanding of the temporal and mechanistic dynamics of coagulopathy will be essential for improving treatment strategies and patient outcomes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06549-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144084993","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":"Correction to: Predictive modeling with linear machine learning can estimate glioblastoma survival in months based solely on MGMT‑methylation status, age and sex","authors":"Emanuele Maragno,&nbsp;Sarah Ricchizzi,&nbsp;Nils Ralf Winter,&nbsp;Sönke Josua Hellwig,&nbsp;Walter Stummer,&nbsp;Tim Hahn,&nbsp;Markus Holling","doi":"10.1007/s00701-025-06554-z","DOIUrl":"10.1007/s00701-025-06554-z","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06554-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144073631","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":"HMGA2 is an independent prognostic indicator and a potential therapeutic target for IDH-mutant astrocytoma","authors":"Luying Wan,&nbsp;Ziyi Liu,&nbsp;Shunyao Li,&nbsp;Zhe Gao","doi":"10.1007/s00701-025-06548-x","DOIUrl":"10.1007/s00701-025-06548-x","url":null,"abstract":"<div><h3>Purpose</h3><p>Although IDH-mutant astrocytomas exhibit more favorable survival outcomes compared to their IDH-wildtype counterparts, therapeutic failure in recurrent cases persists as a significant clinical challenge. The objective of this study is to identify genes associated with recurrence in IDH-mutant astrocytoma and to elucidate their expression pattern, biological functions, and prognostic value.</p><h3>Methods</h3><p>RNA-sequencing data of patients with IDH-mutant astrocytoma were collected from 96 cases in the Chinese Glioma Genome Atlas (CGGA) database, 150 cases in CGGA2019 and 222 cases in The Cancer Genome Atlas (TCGA). Differentially expressed genes (DEGs) were identified using unpaired t-tests between recurrent and primary IDH-mutant astrocytoma. GO and KEGG analyses were performed to analyze these DEGs. Pearson correlation analysis was employed to assess the correlation between High mobility group AT-hook 2 (HMGA2) and genes associated with cell invasion and extracellular matrix components. Kaplan–Meier analyses and univariate and multivariate Cox regression analyses were conducted to assess the prognosis.</p><h3>Results</h3><p>HMGA2 was highly expressed in patients with recurrent IDH-mutant astrocytoma in comparison to those with primary IDH-mutant astrocytoma. Patients with higher HMGA2 expression are more likely to have high-grade gliomas and to be in the O6-methylguanine-DNA methyltransferase promoter (MGMTp) methylation group. Functional enrichment and correlation analyses revealed that HMGA2 is closely related to extracellular matrix content and cell migration and invasion ability. HMGA2 is an independent prognostic factor associated with poor prognosis in patients with IDH-mutant astrocytoma.</p><h3>Conclusions</h3><p>HMGA2 was highly expressed in recurrent IDH-mutant astrocytoma, with higher expression levels associated with increased cell migration and invasion abilities. HMGA2 has the potential to serve as a biomarker for poor prognosis and may represent an effective therapeutic target in the treatment of IDH-mutant astrocytoma.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06548-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144073629","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":"Letter to the editor regarding: “Defining the caudal limits of the endoscopic endonasal approach to the craniovertebral junction: anatomic study correlating radiographic measures”","authors":"Masanori Yonenaga,&nbsp;Hitoshi Yamahata,&nbsp;Shingo Fujio,&nbsp;Yushi Nagano,&nbsp;Tomoko Hanada,&nbsp;Ryutaro Makino,&nbsp;Ryosuke Hanaya","doi":"10.1007/s00701-025-06565-w","DOIUrl":"10.1007/s00701-025-06565-w","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06565-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144073630","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":"Recovery of neurological complications following endovascular parent artery occlusion of ruptured a2 segment anterior inferior cerebellar artery aneurysm: a case report","authors":"Young-Soo Chang,&nbsp;Sun-Yoon Chung","doi":"10.1007/s00701-025-06517-4","DOIUrl":"10.1007/s00701-025-06517-4","url":null,"abstract":"<div><p>Aneurysms of the a2 segment of the anterior inferior cerebellar artery have a high incidence of nonsacullar morphology compelling parent artery occlusion (PAO) as treatment. Well-developed leptomeningeal collaterals and bypass surgery may reduce the occurrence of ischemic complications, but if PAO was made on the segment involving the origin of the internal auditory artery, complications are challenging to avoid. Few studies have clearly described the clinical course of neurologic deficits following PAO of a2 aneurysms. We report a case which recovered from audiovestibular loss and facial palsy after endovascular PAO of a ruptured a2 aneurysm and discuss indication of PAO.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06517-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144073613","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":"Intraosseous ultrasound for assessment of pedicle screw holes in the thoracolumbar spine based on endoscopic ultrasound: An experimental study","authors":"Yun Dong,&nbsp;XiongXiong Zuo,&nbsp;HaiTao Sun,&nbsp;He Wang,&nbsp;ShaoHui He,&nbsp;JianRu Xiao,&nbsp;XiaoPan Cai","doi":"10.1007/s00701-025-06547-y","DOIUrl":"10.1007/s00701-025-06547-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Experimental assessment of the efficiency of intraosseous ultrasound (IOUS) utilizing the mini probe of endoscopic ultrasound (EUS) is performed to determine the accuracy of pedicle screw hole placements in thoracolumbar spine.</p><h3>Methods</h3><p>Drill holes in 76 pedicles of thoracolumbar spines from 2 cases of goats. Each pedicle screw hole is subjected to a 360° circumferential IOUS scanning with a catheter-type mini ultrasound probe of EUS and to a CT examination. Subsequently, all ultrasound images were independently interpreted by 3 reviewers without knowledge of the real position of screw holes and the results of the CT examination for the assessment of screw hole malposition and pedicle cortex breach. Finally, according to the conclusion of CT, a Chi-square test is employed to assess the differences of interpretations of the screw hole malposition among the all reviewers and the relevant relationship between the recognition of the misplaced screw holes and imaging methods utilized.</p><h3>Results</h3><p>CT revealed 13 correctly positioned holes and 63 holes deviating from correct position (including holes that penetrated the cortex). All ultrasound images with malposition identified by CT were correctly interpreted, with no false negatives and no intra-reviewer differences. There were no omissions of severe malposition (including the spinal canal was penetrated into). Excluding six false positives misjudged due to the intersection of screw holes on both sides, there was also no discrepancy between the EUS and CT imaging in the interpretation of screw hole malposition. The examination time of each pedicle screw hole with EUS took less than 15 s.</p><h3>Conclusion</h3><p>EUS-based IOUS is an immediate, reliable and lower-cost technique for accurate determination of pedicle screw hole malposition. With a probe that is both flexible and not easily bendable, the EUS is particularly suitable for IOUS, especially in the narrow space of the bone gaps or bone canals, and minimally invasive spine surgery (MISS).</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06547-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949442","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":"Influence of laboratory and radiographic parameters on the clinical presentation and outcome of surgically treated patients with primary brain abscesses","authors":"Adrian Liebert,&nbsp;Thomas Eibl,&nbsp;Dimitri Lukin,&nbsp;Ralph Bertram,&nbsp;Joerg Steinmann,&nbsp;Karl-Michael Schebesch,&nbsp;Leonard Ritter","doi":"10.1007/s00701-025-06559-8","DOIUrl":"10.1007/s00701-025-06559-8","url":null,"abstract":"<div><h3>Background</h3><p>Brain abscesses can lead to severe clinical outcomes, including death. Most studies on brain abscesses focus either on patient cohorts including postsurgical/posttraumatic abscesses. This study aimed to assess the clinical presentation and postoperative outcomes in a homogeneous group of patients with primary, pyogenic brain abscesses who underwent surgical treatment.</p><h3>Methods</h3><p>We retrospectively analyzed consecutive patients with pyogenic brain abscesses treated surgically at our center from 2008 to 2023. The primary endpoint was a modified Rankin Scale (mRS) score of ≥ 3 at discharge. Secondary endpoint was preoperative clinical status (mRS ≥ 3). We statistically correlated clinical, radiographic, and microbiological parameters with these endpoints.</p><h3>Results</h3><p>A total of 60 patients (36.7% female) with a mean age of 48.5 ± 20.8 years were included in this study. Six patients (10.0%) had an unfavorable postoperative outcome, including two deaths (3.3%). Significant risk factors for poor outcomes included preoperative disturbance of consciousness (DOC) (<i>p</i> = 0.012) and elevated preoperative C-reactive protein (CRP) levels (<i>p</i> = 0.002). Larger abscess volume (37.4 mL vs. 16.1 mL, <i>p</i> = 0.065) and shorter mean distance to the ventricles (3 mm vs. 11.42 mm, <i>p</i> = 0.086) trended toward significance. The length of intensive care unit (ICU) stay was significantly longer for patients with unfavorable outcomes (<i>p</i> = 0.001). Upon admission, eighteen patients (30.0%) had an mRS score of ≥ 3. Elevated leukocyte count was identified as a significant risk factor for poor preoperative status (<i>p</i> = 0.007). Median clinical performance, measured by mRS, improved throughout the treatment course and during follow-up from 2 to 0.</p><h3>Conclusions</h3><p>Preoperative DOC and elevated CRP levels were identified as predictors of unfavorable outcomes. Elevated leukocyte count was a predictor for poor preoperative status.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06559-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143949443","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":"Management of vascular encasement in parasellar meningiomas—How I Do It","authors":"Sorin Aldea,&nbsp;Floriana Halimi,&nbsp;Caroline Le Guerinel","doi":"10.1007/s00701-025-06502-x","DOIUrl":"10.1007/s00701-025-06502-x","url":null,"abstract":"<div><h3>Background</h3><p>Tumours of the parasellar area may engulf the internal carotid artery(ICA) and its branches which may preclude complete resection and may be a risk factor for ischemic complications.</p><h3>Methods</h3><p>We present a surgical technique based on a stepwise identification of the arterial branches which may enable a complete resection in selected cases even when complete encasement of the ICA is present on preoperative images.</p><h3>Conclusion</h3><p>Resection of tumours encasing the major vascular structures should be systematically attempted while continuously weighing the delicate balance between the risk of vascular injury and the extent of resection.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06502-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944311","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":"How I do it: minimally invasive surgical decompression for lumbosacral extraforaminal stenosis (Far-Out Syndrome)","authors":"Subum Lee,&nbsp;Sunghyun Kwon,&nbsp;Seok-Joon Kim,&nbsp;Jun-Hyeok Song","doi":"10.1007/s00701-025-06553-0","DOIUrl":"10.1007/s00701-025-06553-0","url":null,"abstract":"<div><h3>Background</h3><p>Accurate diagnosis of extraforaminal entrapment of the L5 nerve root, commonly referred to as \"far-out syndrome,\" is challenging due to its unique anatomical characteristics, which differ from those of other lumbar regions. Inadequate decompression may lead to poor outcomes.</p><h3>Method</h3><p>A minimally invasive paraspinal approach utilizing a tubular retractor was used to decompress extraforaminal entrapment of the L5 nerve root. Procedures and discussions regarding indications, diagnoses, surgical endpoints, and ways to avoid complications were described.</p><h3>Conclusion</h3><p>Adequate decompression requires sufficient resection of the L5 lower vertebral body bony spur, transverse process, and sacral ala as a ventral margin.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06553-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143944310","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}