Acta Neurochirurgica最新文献

{"title":"One-piece bifrontal basal craniotomy with pericranial flap for frontal sinus management: How I Do It","authors":"Eiji Ito,&nbsp;Ryotaro Sugita,&nbsp;Mao Yokota,&nbsp;Tadashi Watanabe","doi":"10.1007/s00701-025-06528-1","DOIUrl":"10.1007/s00701-025-06528-1","url":null,"abstract":"<div><h3>Background</h3><p>Anterior skull base surgery poses challenges including cerebrospinal fluid (CSF) leakage and cosmetic concerns. A novel one-piece bifrontal basal craniotomy using a pericranial flap was developed to improve outcomes.</p><h3>Method</h3><p>The technique included precise burr hole placement, dura-protective craniotomy, and frontal sinus sealing using a pericranial flap. Reconstruction was stabilized using miniplates and screws, leaving the epidural dead space unfilled and lowering infection risks.</p><h3>Conclusion</h3><p>This method reduces CSF leakage, enhances reconstruction durability, and preserves cosmetic and functional outcomes, offering a reliable approach for anterior skull base surgery.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06528-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143840289","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":"Detection of remnants in clipped unruptured intracranial aneurysms by intraoperative CT-angiography and postoperative DSA: clinical relevance and follow-up","authors":"Jun Thorsteinsdottir,&nbsp;Julian Schwarting,&nbsp;Robert Forbrig,&nbsp;Sebastian Siller,&nbsp;Joerg-Christian Tonn,&nbsp;Thomas Liebig,&nbsp;Christian Schichor","doi":"10.1007/s00701-025-06518-3","DOIUrl":"10.1007/s00701-025-06518-3","url":null,"abstract":"<div><h3>Background</h3><p>Aneurysm clipping is routinely performed with high efficacy and low complication rates in specialized neurovascular centers. Postoperative aneurysm remnants bear the risk of growth/rupture. Study aim was to analyze remnants in postoperative angiography (pDSA) and follow-up (FU) and to evaluate whether use of intraoperative CT-angiography (iCTA) can intraoperatively detect remnants and enable therapeutic consequences.</p><h3>Methods</h3><p>All patients undergoing elective aneurysm clipping at our center between 11/2012 and 12/2019 were included for FU in 01/2024. All patients received Indocyanin-green-videoangiography (ICGVA) and postoperative angiography (pDSA). After iCTA implementation in 10/2016, the majority of patients received additionally iCTA. Baseline characteristics, treatment-related morbidity/outcome, resulting operative conclusions in distinct cohorts with/without iCTA, and management of remnants according to Sindou classification were analyzed.</p><h3>Results</h3><p>270 patients (367 enrolled/97 excluded) were clipped using iCTA in 74 patients. In 12/270 patients (4.5%) clip repositioning was performed due to ICGVA results, but iCTA further detected large remnants intraoperatively in 3/74 patients (4.1%) correctly resulting in re-clipping in two patients and recommendation for endovascular therapy in one patient. The specificity, sensitivity, and accuracy for detection of Sindou grade (SG) III-IV remnants by iCTA were 100%, 75%, and 98.6%, respectively. Overall, pDSA detected SG I-II remnants in 32/270 (11.9%) and SG III-V remnants in 8/270 (3.0%) patients with 3/270 requiring retreatment (<i>n</i> = 1 resurgery, <i>n</i> = 2 endovascular therapy). Frequency of SG I-V and III-V remnants were slightly lower in iCTA than non-iCTA group (10.8 vs. 16.3%, <i>p</i> &lt; 0.173 and 1.4 vs. 3.6%, <i>p</i> &lt; 0.306). All SG I-II and five SG III-V remnants did not reveal growth/rupture after a mean FU of 29 months.</p><h3>Conclusions</h3><p>Aneurysm remnants after clipping are rare and predominantly small (SGI-II)—not harbouring a risk of growth/rupture during short-term FU. Intraoperative CTA can detect large aneurysm remnants (SG III-IV) and may prompt adjustment of surgical strategy in individual cases.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06518-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143840290","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":"Distal protection of endovascular recanalization for symptomatic non-acute occlusion of vertebrobasilar artery","authors":"Qiuli Li,&nbsp;Xiaoxi Yao,&nbsp;Yuanbiao Lei,&nbsp;Haipeng Li,&nbsp;Liu Tu,&nbsp;Yi Zhang","doi":"10.1007/s00701-025-06525-4","DOIUrl":"10.1007/s00701-025-06525-4","url":null,"abstract":"<div><h3>Purpose</h3><p>The research aimed to investigate the safety and efficacy of distal protection of endovascular recanalization for symptomatic non-acute occlusion of the intracranial vertebrobasilar artery.</p><h3>Methods</h3><p>8 consecutive patients with symptomatic non-acute VBA from April 2023 to April 2024 who underwent endovascular recanalization were retrospectively analyzed.</p><h3>Results</h3><p>8 patients (median age 56 years; mean pretreatment National Institutes of Health Stroke Scale (NIHSS) score 6; 87.5% male) presenting with recurrent transient ischemic attacks(TIAs) (n = 1) or strokes (n = 23) were treated from April 2023 to April 2024. Median time from symptoms onset to treatment was 21 days(range: 10–43). Median time from occlusion confirmed to treatment was 13 days(range:8–26). Among the 8 patients, 8 (100%) achieved successful recanalization. The rate of periprocedural complications was 25%(2/8). Periprocedural complication included one asymptomatic intracranial hemorrhage(asICH) and thrombus translocation. The median follow-up time was 9 months (range: 6–12), with no stroke or TIA. At 90 days, there were one death (unrelated to the procedure) and 75% patients with an available modified Rankin Scale (mRS) score achieved a good outcome (mRS score of 0–2).</p><h3>Conclusion</h3><p>The distal protection of stent retriever for endovascular recanalization for symptomatic non-acute occlusion of VBA is technically safe and may decrease procedure-related complications.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06525-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830707","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":"The British object and action naming test for intraoperative mapping (BOATIM): A standardised and clinically tested framework for awake brain surgery","authors":"Hajira Mumtaz,&nbsp;Anna E. Piasecki,&nbsp;Minna Kirjavainen,&nbsp;Margaret Newson,&nbsp;Madeleine Farrow,&nbsp;Molly Cree,&nbsp;Neil U. Barua","doi":"10.1007/s00701-025-06521-8","DOIUrl":"10.1007/s00701-025-06521-8","url":null,"abstract":"<div><h3>Background</h3><p>Picture-naming tasks are widely used for identifying speech-eloquent regions during awake craniotomy. However, language-specific and culturally relevant task stimuli remain scarce. Current practices mostly rely on translated stimuli that do not reflect the everyday language use of the target speakers and might be susceptible to misinterpretations due to linguistic and cultural differences. Additionally, non-standardised homemade tasks are used. Here, we, for the first time, present the development, standardisation, and clinical application of two tests designed specifically for functional mapping in British English.</p><h3>Methods</h3><p>115 object and 86 action stimuli were developed using the British National Corpus (BNC) and controlled for confounding psycholinguistic variables using normative data from native speakers. Optimization of the items for intraoperative use was done by first standardising the tests in healthy volunteers followed by their application during the electrical stimulation of language-eloquent regions in brain tumour patients. In the standardised data, the influence of word- and subject-related factors on performance, and the test-retest reliability was explored.</p><h3>Results</h3><p>The final items achieved above 80% naming agreement. Object naming proved easier compared to action naming, with accuracy positively influenced by word frequency and negatively affected by the age-of-acquisition variable in both tasks. No subject-related effects were found. Excellent test-retest reliability confirmed the consistency of the tests in measuring language abilities. Positive maps obtained during intraoperative functional mapping demonstrated the sensitivity of the tests in detecting speech-eloquent regions.</p><h3>Conclusion</h3><p>The tests provide a reliable and robust tool containing stimuli that are linguistically and culturally appropriate to British-English speakers.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06521-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830705","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":"Lack of correlation between cerebral arteriovenous malformation angioarchitectural and hemodynamic characteristics and systemic inflammation","authors":"Tatiana Abou-Mrad,&nbsp;Laura Stone McGuire,&nbsp;Jessica Hossa,&nbsp;Peter Theiss,&nbsp;Mpuekela Tshibangu,&nbsp;Adrusht Madapoosi,&nbsp;Fady T. Charbel,&nbsp;Ali Alaraj","doi":"10.1007/s00701-025-06464-0","DOIUrl":"10.1007/s00701-025-06464-0","url":null,"abstract":"<div><h3>Purpose</h3><p>Plasma-based inflammatory biomarkers have gained attention in cerebrovascular pathologies, with studies suggesting links to high-risk features. This study investigates the association between systemic inflammatory markers and cerebral arteriovenous malformation (AVM) angioarchitectural and hemodynamic characteristics.</p><h3>Methods</h3><p>A single-center database of AVM patients (2007–2023) was queried. Patients with unruptured, supratentorial AVMs, baseline quantitative magnetic resonance angiography, and complete blood counts at admission were included. Biomarkers analyzed included white blood cell (WBC) count, absolute neutrophil count (ANC), absolute monocyte count (AMC), absolute lymphocyte count (ALC), and platelet count. Neutrophil–lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), and systemic inflammation index (SII) were calculated. AVM characteristics and hemodynamic properties were assessed.</p><h3>Results</h3><p>86 patients met inclusion criteria. No significant correlations were found between systemic inflammatory markers and AVM size, morphology, venous stenosis, or Spetzler-Martin grade. While WBC count and ANC weakly correlated with flow index (<i>p</i> &lt; 0.05), AVM flow showed no consistent associations with inflammatory markers.</p><h3>Conclusion</h3><p>Systemic inflammatory markers do not consistently correlate with unruptured AVM angioarchitecture or hemodynamics. These findings suggest systemic inflammation may have limited relevance to sporadic AVM pathology. Future studies should explore localized inflammatory biomarkers to better understand AVM behavior.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06464-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143830706","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":"Reliability of surgeon-reported MRI findings to a national spine register","authors":"Ole Kristian Alhaug,&nbsp;Håvard Furunes,&nbsp;Simran Kaur,&nbsp;Nynne Blomfeldt,&nbsp;Filip C. Dolatowski","doi":"10.1007/s00701-025-06524-5","DOIUrl":"10.1007/s00701-025-06524-5","url":null,"abstract":"<div><h3>Purpose</h3><p>Spine registries contribute to valuable knowledge and research; however, the data quality has been questioned. MRI findings are crucial for diagnostics and grading of degenerative spinal disorders. We aimed to explore the reliability of surgeon-reported MRI findings in a national spine registry (NORspine).</p><h3>Methods</h3><p>We assessed the reliability of MRI findings from three spine centres. Two spine surgeons re-examined previously surgeon-reported MRI findings for a sample of NORspine patients. We assessed the inter-rater reliability and the reliability between the NORspine registry and each study rater by Cohen's Kappa (ƙ).</p><h3>Results</h3><p>Two spine surgeons reassessed preoperative MRI of the lumbar spine for 276 previously enrolled NORspine patients; 92 at each treating centre equally distributed by three categories of spinal procedures: removal of disc herniation (LDH), decompression of lumbar spinal stenosis (LSS), and lumbar fusion. The inter-rater reliability varied from fair (0.21) to substantial (0.75) (most reliable for detecting LDH and LSS). The reliability between the NORspine registry and each rater varied from slight (0.13) to substantial (0.75). The highest reliability was found for LDH and LSS (ƙ = 0.72–0.75), while degenerative disc (DDD), foraminal stenosis (FS) and Modic changes had lower reliability (ƙ = 0.27–0.49).</p><h3>Conclusion</h3><p>The reliability for surgeon-reported MRI diagnostics to the NORspine registry varied and was substantial for LDH and LSS, moderate for DDD and FS, and slight or fair for Modic changes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06524-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826588","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":"Exo- and endoscopic two-step approach for anterior foramen magnum meningiomas: How I do it","authors":"Kenichiro Iwami,&nbsp;Yuichi Nagata,&nbsp;Tadashi Watanabe,&nbsp;Ryuta Saito","doi":"10.1007/s00701-025-06512-9","DOIUrl":"10.1007/s00701-025-06512-9","url":null,"abstract":"<div><p>Anterior foramen magnum (AFM) meningiomas are difficult to treat because they are situated in anatomically complex regions. One of the most common approaches for AFM meningiomas is the far lateral approach. We describe our exo- and endoscopic two-step approach (EETA) through suboccipital craniotomy. An exoscope is used to remove the tumour’s lateral part, whereas an endoscope is used to remove the residual tumour in the exoscope’s blind spots, including the brainstem’s ventral side. EETA is a viable option for treating AFM meningiomas because it provides an adequate surgical field of view and is minimally invasive.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06512-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143826587","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":"Effects of metformin use on aneurysmal subarachnoid hemorrhage outcomes","authors":"Angel Bueno,&nbsp;Andrea Becerril-Gaitan,&nbsp;Collins Mokua,&nbsp;Kristina Ramirez-Garcia,&nbsp;Justin Nguyen,&nbsp;Faris Shaker,&nbsp;Tien Nguyen,&nbsp;Antonio Dono,&nbsp;Spiros Blackburn,&nbsp;Peng Roc Chen,&nbsp;Mark Dannenbaum,&nbsp;H. Alex Choi,&nbsp;Arthur L. Day,&nbsp;Jacques J. Morcos,&nbsp;Ching-Jen Chen","doi":"10.1007/s00701-025-06516-5","DOIUrl":"10.1007/s00701-025-06516-5","url":null,"abstract":"<div><h3>Background</h3><p>Metformin is widely prescribed and has neuroprotective effects in animals, but its impact on brain injury after aneurysmal subarachnoid hemorrhage (aSAH) in humans is unclear.</p><h3>Methods</h3><p>This single-center retrospective review assessed patients with aSAH from 2009 to 2023, categorizing them based on pre-admission metformin use. The primary outcome was delayed cerebral ischemia (DCI), while secondary outcomes included in-hospital mortality, rebleeding, angiographic cerebral vasospasm (CVS), and favorable modified Rankin Scale (mRS) scores at discharge and the 3-month follow-up. Outcomes were analyzed using logistic regression. Sensitivity analysis was performed after excluding patients receiving comfort care.</p><h3>Results</h3><p>A total of 900 patients were included (47 metformin and 853 non-metformin). DCI rates were similar between groups (38.3% vs. 29.3%, aOR = 1.06 [0.49–2.28]). Rebleeding rates were 4.3% for metformin users and 5.6% for non-users (aOR = 0.47 [0.09–2.51]). In-hospital mortality was 4.3% in metformin users vs. 9.7% in non-users (aOR = 0.47 [0.08–2.84]). Angiographic CVS was 38.3% in metformin users and 52.8% in non-users (aOR = 0.49 [0.23–1.05]), and at 7 days, CVS was 29.8% vs. 47.6% (aOR = 0.46 [0.21–1.01]). Sensitivity analysis showed similar DCI rates (39.1% vs. 30.9%, aOR = 0.98 [0.45–2.15]) but lower CVS at 7 days for metformin users (aOR = 0.44 [0.20–0.98]).</p><h3>Conclusion</h3><p>Metformin use before aSAH did not significantly affect the risk of DCI or CVS. However, after excluding comfort care patients, the findings are highly speculative of reduced CVS risk at 7 days post-aSAH. Rebleeding and mortality rates were similar across groups. Future research with larger, multi-institutional datasets is needed to better understand metformin's impact, particularly during and after aSAH.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06516-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143809237","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":"Employing large language models safely and effectively as a practicing neurosurgeon","authors":"Advait Patil,&nbsp;Paul Serrato,&nbsp;Gracie Cleaver,&nbsp;Daniela Limbania,&nbsp;Alfred Pokmeng See,&nbsp;Kevin T. Huang","doi":"10.1007/s00701-025-06515-6","DOIUrl":"10.1007/s00701-025-06515-6","url":null,"abstract":"<div><h3>Background</h3><p>Large Language Models (LLMs) have demonstrated significant capabilities to date in working with a neurosurgical knowledge-base and have the potential to enhance neurosurgical practice and education. However, their role in the clinical workspace is still being actively explored. As many neurosurgeons seek to incorporate this technology into their local practice environments, we explore pertinent questions about how to deploy these systems in a safe and efficacious manner.</p><h3>Methods</h3><p>The authors performed a literature search of LLM studies in neurosurgery in the PubMed database (“LLM” and “neurosurgery”). Papers were reviewed for LLM use cases, considerations taken for selection of specific LLMs, and challenges encountered, including processing of private health information.</p><h3>Results</h3><p>The authors provide a review of core principles underpinning model selection, including technical considerations such as model access, context windows, multimodality, retrieval-augmented generation, and benchmark performance, as well as relative advantages of current LLMs. Additionally, the authors discuss safety considerations and paths for institutional support in safe LLM inference on private health data. The resulting discussion forms a framework for key dimensions neurosurgeons employing LLMs should consider.</p><h3>Conclusions</h3><p>LLMs present promising opportunities to advance neurosurgical practice, but their clinical adoption necessitates careful consideration of technical, ethical, and regulatory hurdles. By thoughtfully evaluating model selection, deployment approaches, and compliance requirements, neurosurgeons can leverage the benefits of LLMs while minimizing potential risks.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06515-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801221","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: Optic nerve decompression in patient with osteopetrosis","authors":"Katarína Horčičáková,&nbsp;Jana Táborská,&nbsp;Adéla Bubeníková,&nbsp;Vladimír Beneš 3rd","doi":"10.1007/s00701-025-06513-8","DOIUrl":"10.1007/s00701-025-06513-8","url":null,"abstract":"<div><h3>Background</h3><p>Osteopetrosis is a rare genetic disorder causing excessive skeletal density, with a predilection to affect the skull base. This commonly leads to optic canal stenosis, optic nerve compression, and atrophy and vision loss. Timely optic nerve decompression can be an effective surgical intervention to preserve vision.</p><h3>Methods</h3><p>Pterional approach combining both extra- and intradural optic nerve decompression was performed. Intradural optic nerve identification proved a helpful and safe way to facilitate adequate decompression while dissecting in the region of hypertrophic anterior clinoid process.</p><h3>Conclusion</h3><p>Precise surgical technique and anatomical awareness are crucial for minimizing complications and aiding recovery.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06513-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143801220","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}