Acta Neurochirurgica最新文献

{"title":"Risk factors and prognosis of visual and cranial nerve deficits in patients operated for pituitary tumor - with a focus on intrasellar pressure.","authors":"Gabriel Simander, Peter Lindvall, Per Dahlqvist, Lars-Owe D Koskinen","doi":"10.1007/s00701-025-06668-4","DOIUrl":"https://doi.org/10.1007/s00701-025-06668-4","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate if intrasellar pressure (ISP) is associated with the risk of visual impairment in patients with a pituitary tumor, and the prognosis for visual function after tumor surgery.</p><p><strong>Method: </strong>Retrospective, single-center study including 100 consecutive patients operated for a pituitary tumor, who had their ISP measured. Data on patient and tumor characteristics, pre- and postoperative visual acuity, visual fields, and cranial nerve III, IV, and VI deficits were collected from patient files.</p><p><strong>Results: </strong>Before surgery, 64% had visual acuity impairment and 65% visual field deficits. Postoperatively, the frequencies were 40% for visual acuity impairment and 41% for visual field deficits. Risk factors for preoperative visual impairment were tumor volume, suprasellar tumor extension (SIPAP grade 3-4), and female sex. ISP was associated with higher risk of visual acuity impairment at postoperative follow up. No other correlations between ISP and pre- or postoperative visual and cranial nerve outcome were found. Age was associated with lower chance of visual acuity improvement and increased risk of visual field deficits postoperatively.</p><p><strong>Conclusion: </strong>Overall, ISP does not seem to play an important role as a risk factor or prognostic factor for visual and cranial nerve impairment in pituitary tumor disease. However, ISP showed an association with postoperative visual acuity impairment. The clinical relevance of this results is not straight-forward. Tumor size, suprasellar growth pattern, and female sex are confirmed risk factors for preoperative visual symptoms. High age appears to negatively influence visual outcome after surgery.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"266"},"PeriodicalIF":1.9,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basilar apex artery aneurysm clipping: how I do it.","authors":"Paolo Palmisciano, Sudhakar Vadivelu, Norberto Andaluz, Mario Zuccarello","doi":"10.1007/s00701-025-06687-1","DOIUrl":"https://doi.org/10.1007/s00701-025-06687-1","url":null,"abstract":"<p><p>Approximately 5-8% of intracranial aneurysms arise from the basilar artery apex (BAA). Given the basilar artery role in supplying the brainstem and the posterior cerebral circulation, the rates of morbidity and mortality are especially high in case of rupture. Although endovascular occlusion techniques are overall favored, thus leading to decreasing surgical expertise, complex BAA aneurysm may still require treatment with microsurgical occlusion. We describe our institutional perioperative protocol in the management of BAA aneurysms, focusing on surgical anatomy, approach selection, and intraoperative nuances.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"267"},"PeriodicalIF":1.9,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How I do it – extracranial-intracranial bypass surgery integrating STA-MCA anastomosis, synangiosis, MMA supply, and preservation of recipient artery perforators: the Integrated Method","authors":"Milad Neyazi,&nbsp;Rajiv Kumar Khajuria,&nbsp;Katharina Faust,&nbsp;Sajjad Muhammad","doi":"10.1007/s00701-025-06689-z","DOIUrl":"10.1007/s00701-025-06689-z","url":null,"abstract":"<div><h3>Background</h3><p>Extracranial-intracranial (EC-IC) bypass is an effective revascularization technique for flow augmentation in conditions like Moyamoya disease and ischemic cerebrovascular disorders. The approach described here combines direct bypass (STA-MCA anastomosis), indirect bypass (encephaloduromyosynangiosis, EDMS), preservation of the middle meningeal artery (MMA), and preservation of recipient artery perforators to optimize outcomes.</p><h3>Method</h3><p>This article outlines a comprehensive surgical strategy emphasizing anatomical considerations, procedural nuances, and the integration of direct and indirect techniques while preserving MMA and recipient artery perforators to augment collateral circulation.</p><h3>Conclusion</h3><p>The Integrated Method described here encompasses four technical aspects so as to enhance revascularization, minimize complications, and improve long-term outcome in carefully selected patients.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06689-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145210637","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":"Risk Factors for Postoperative Cerebrospinal Fluid Fistulas After Craniotomy and Craniectomy: A Systematic Review and Meta-Analysis","authors":"Matteo Palermo,&nbsp;Fabio Zeoli,&nbsp;Valid Rastegar,&nbsp;Carmelo Lucio Sturiale,&nbsp;Francesco Signorelli","doi":"10.1007/s00701-025-06685-3","DOIUrl":"10.1007/s00701-025-06685-3","url":null,"abstract":"<div><h3>Introduction</h3><p>Postoperative CSF fistulas are a common complication in cranial neurosurgery. While efforts to prevent CSF leaks typically focus on surgical technique, it remains unclear whether tumor location, type of pathology, or specific closure methods independently influence fistula development. Clarifying these risk factors is essential to guide intraoperative decision-making and improve patient outcomes.</p><h3>Methods</h3><p>We conducted a systematic search limited to peer-reviewed studies published in English on multiple databases. The search algorithm retrieved 1,348 results. After the exclusion phase, we included 26 comparative studies in the final analysis, collectively reporting data on 8,248 patients who underwent either craniotomy or craniectomy. After a systematic review, we performed a meta-analysis when sufficient data were available from multiple studies for a specific risk factor.</p><h3>Results</h3><p>Infratentorial surgeries had a higher CSF leak rate (7.9%) than supratentorial ones (4.6%). Tumor surgeries showed greater risk than vascular procedures (OR: 1.82). Primary closure had a higher leak rate (12.3%) compared to patch grafts (8.5%). Watertight closure showed a trend toward fewer leaks than non-watertight closure, though not statistically significant. CSF leaks were strongly associated with postoperative infections (34.1%).</p><h3>Conclusion</h3><p>Infratentorial location, tumor surgery, and sural closure increase the risk of postoperative CSF leaks. Patch grafts and watertight techniques lower this risk. Given the strong association with infections, preventing CSF leaks is essential to improve surgical outcomes.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06685-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145210781","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":"Intraoperative integration of nTMS, CCEPs and DCS for language. A glance to the next future?","authors":"Camilla Bonaudo,&nbsp;Riccardo Carrai,&nbsp;Edoardo Pieropan,&nbsp;Francesca Fedi,&nbsp;Eleonora Visocchi,&nbsp;Fabrizio Baldanzi,&nbsp;Francesca Battista,&nbsp;Antonello Grippo,&nbsp;Alessandro Della Puppa","doi":"10.1007/s00701-025-06691-5","DOIUrl":"10.1007/s00701-025-06691-5","url":null,"abstract":"<div><h3>Background</h3><p>Direct-Cortical-Stimulation (DCS), Navigated-Transcranial Magnetic-Stimulation (nTMS), Cortico-Cortical-Evoked-Potentials (CCEPs) can be synergically used to monitor Language-network.</p><h3>Methods</h3><p>We illustrate a case of multimodal approach for removal of one left fronto-temporo-insular Low-Grade-Glioma.</p><h3>Results</h3><p>A 32-years-old female patient was operated in awake surgery (using D080-picture-naming-test). We documented a matching correspondence among frontal nTMS + spots, Penfield DCS, and CCEPs stimulation strip. The same was found in the temporal area among nTMS, DCS, and CCEPs recording strip. [Average distance among nTMS, DCS and CCEPs spots = 5.10 mm, STD = 1.08 mm. Se, PPV and Precision:100%].</p><h3>Conclusions</h3><p>We documented the potential utility of matching synergic technologies to preserve language.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06691-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145210782","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":"A case of hypertension due to iatrogenic glossopharyngeal neuropathy after aesthetic procedure","authors":"Erdinç TUNÇ,&nbsp;Tansel Turan,&nbsp;İrem Hengirmen Acu,&nbsp;Hatice Aygun","doi":"10.1007/s00701-025-06674-6","DOIUrl":"10.1007/s00701-025-06674-6","url":null,"abstract":"<div><p>In our case, we report a previously unreported complication of a thread lift procedure in the jowl region. This complication was caused by damage to the glossopharyngeal nerve through compression. The case also illustrates the diagnostic and therapeutic aspects of iatrogenic injury to the glossopharyngeal nerve. The widespread use of thread lift in aesthetic medicine has increased the variety and frequency of complications. The thread lift procedure is an blind intervention in which critical anatomical structures are not directly visualised. Therefore, the risk of damage to various structures is also high. Damage to the nerves in the application area is manifested by specific symptoms such as sensory deficits, pain, swallowing impairment, and autonomic dysfunction. We describe the diagnosis and treatment of a glossopharyngeal nerve injury caused by compression of the nerve trunk following a facial thread lift procedure.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06674-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197775","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":"Introducing e-Motions: a novel intraoperative test for social cognition mapping. Triple validation in normative, schizophrenia, and autism spectrum disorder populations","authors":"Jesús Martín-Fernández,&nbsp;Nayra Caballero-Estebaranz,&nbsp;Esteban Félez,&nbsp;Pedro Pérez del Rosario,&nbsp;Francisco Rodríguez Pulido,&nbsp;Natalia Navarro-Peris,&nbsp;Fernando Martínez,&nbsp;Andrés Cervio,&nbsp;Isabel Martín-Monzón","doi":"10.1007/s00701-025-06661-x","DOIUrl":"10.1007/s00701-025-06661-x","url":null,"abstract":"<div><h3>Background</h3><p>Social cognition is essential for daily functioning, as it influences quality of life, return to work, and interpersonal communication. While schizophrenia and autism spectrum disorder (ASD) have been the paradigmatic conditions in which social cognition is markedly impaired, emerging evidence suggests that up to 30% patients with brain tumors may experience persistent deficits in this domain. Despite its clinical relevance, social cognition remains insufficiently studied in neuro-oncology and lacks dedicated intraoperative assessment tools specifically tailored for its use during awake brain surgery.</p><h3>Method</h3><p>This study introduces e-Motions, a new test designed ad hoc to address this gap. The e-Motions test comprises 34 four-second video stimuli depicting two hyper-realistic avatars (one male, one female) expressing complex emotions. These avatars were developed using an AI-based facial motion capture system applied to 60 professional actors. Validation was performed in three groups: (1) healthy adults (<i>n</i> = 226), (2) individuals with schizophrenia (<i>n</i> = 33), and (3) ASD (<i>n</i> = 30).</p><h3>Results</h3><p>Internal consistency (KR-20), test–retest reliability (ICC), and correlations with established social cognition tools (Reading the Mind in the Eyes [RMET], Ekman-60 faces test [Ekman-60F], and the Movie for the Assessment of Social Cognition [MASC]) were evaluated. The e-Motions test demonstrated high global internal consistency (KR-20 = 0.86) and good test–retest reliability (ICC₂,₁ = 0.73). Scores showed positive moderate correlations with both lower-level mentalizing tests (RME: ρ = 0.44; Ekman-60F: ρ = 0.48) and higher-level mentalizing test (MASC: ρ = 0.57). Discriminative power was strong for distinguishing healthy participants from individuals with schizophrenia (AUC = 0.89) and ASD (AUC = 0.79).</p><h3>Conclusions</h3><p>e-Motions test is the first AI-based test created ad hoc for awake brain mapping. Its good internal consistency and significant correlation with low-level and high-level mentalizing tests make this tool a novel, ecological and promising way to identify critical regions involved in social cognition during awake brain mapping. Future studies should be performed to demonstrate its validity preserving this complex higher-order cognitive construct during and after brain tumor surgery.\u0000</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06661-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197940","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: sling transposition technique with biopatch and aneurysm clip for hemifacial spasm","authors":"Sergio Corvino,&nbsp;Vincenzo Seneca,&nbsp;Giorgio Iaconetta,&nbsp;Giuseppe Catapano","doi":"10.1007/s00701-025-06634-0","DOIUrl":"10.1007/s00701-025-06634-0","url":null,"abstract":"<div><h3>Background</h3><p>Microvascular decompression (MVD) represents the only definitive and non-ablative treatment for hemifacial spasm (HS). Teflon is the most used interposing material because considered inert; nevertheless, it is not free from complications.</p><h3>Method</h3><p>We discuss and illustrate our method to resolve the neurovascular conflict accounting for HS through a sling transposition technique using aneurysm clip and biopatch in carefully selected cases.</p><h3>Conclusion</h3><p>Several MVD procedures, including interposing and transposing techniques, have been proposed for HS, mainly selected according to surgeon’s preference. We consider the described technique a definitive treatment, safe, not associated to pain recurrence and without needing revision surgery.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06634-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197886","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 4 F (Fat, Fascia, Fibrin, and Fat) Technique for Skull Base Reconstruction in Endoscopic Transorbital Surgery","authors":"Sergio Corvino,&nbsp;Francesco Corrivetti,&nbsp;Giuseppe Catapano,&nbsp;Giuseppe Corazzelli,&nbsp;Antonio Colamaria,&nbsp;Edisher Maghalashvili,&nbsp;Iacopo Dallan,&nbsp;Domenico Di Maria,&nbsp;Germano Di Matteo,&nbsp;Giorgio Iaconetta,&nbsp;Matteo de Notaris","doi":"10.1007/s00701-025-06667-5","DOIUrl":"10.1007/s00701-025-06667-5","url":null,"abstract":"<div><h3>Background</h3><p>Superior eyelid endoscopic transorbital approach (SETOA) has demonstrated broad versatility in addressing heterogeneous lesions involving the paramedian anterior and middle skull base in carefully selected patients. Although various skull base reconstruction techniques have shown promising results in reducing cerebrospinal fluid (CSF) leaks, no standardized method has yet been established that consistently ensures optimal outcomes in the presence of an intraoperative CSF leak to achieve a watertight seal and minimize the risk of potentially life-threatening complications.</p><h3>Methods</h3><p>Preliminary data from a monoinstitutional surgical series of patients harboring different intracranial lesions, in whom intraoperative CSF leak was detected and who underwent reconstruction during SETOA using a novel method defined “4F”, were retrospectively analyzed. The technique consists of intradural autologous fat graft, extradural fascia lata, fibrin glue and extradural autologous fat graft. Postoperative functional and esthetic outcome, particularly reconstruction-related complications, were assessed over a follow-up period of 14–38 months.</p><h3>Results</h3><p>The surgical series included 16 patients (2 metastases, 1 orbital lymphoma, 10 meningiomas, 2 trigeminal schwannomas, 1 case of postoperative CSF leak). SETOA was performed in 13 cases, while in the remaining three patients an extended lateral rim orbitotomy variant was added. No cases of CSF leak were observed during the follow-up period. The method provided effective reconstruction, with no instances of major or even minor reconstruction-related complications —such as proptosis, enophthalmos, meningoencephalocele, diplopia, new onset ocular paresis or wound infection—and no revision surgeries were required.</p><h3>Conclusion</h3><p>This preliminary experience suggests that the 4F reconstruction technique may be a feasible option for managing osteodural defects during SETOA. It accomplishes the goals of skull base reconstruction, to achieve a watertight closure and avoid dead space. However, given the limited sample size and lack of a control group, definitive conclusions cannot be drawn. Further studies with larger cohorts, standardized outcome measures, and comparative methods are required to assess its final clinical utility.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184506","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":"Lidocaine infusion for the treatment of intractable trigeminal neuralgia: retrospective case series and systematic review","authors":"Mohamed Wael Mohamed,&nbsp;Francis Irem-Oko,&nbsp;Asim Sheikh,&nbsp;Nicholas Phillips,&nbsp;Justin Mckinlay,&nbsp;Ian Anderson","doi":"10.1007/s00701-025-06672-8","DOIUrl":"10.1007/s00701-025-06672-8","url":null,"abstract":"<div><h3>Background</h3><p>Trigeminal neuralgia classically manifests with intense facial pain. When the condition is unresponsive to standard treatment, it is referred to as refractory trigeminal neuralgia.</p><h3>Aims and objectives</h3><p>The study aimed to investigate the effectiveness, duration of pain relief and safety profile of intravenous Lidocaine in managing this debilitating condition.</p><h3>Materials and methods</h3><p>A retrospective case series in a UK tertiary neurosurgery centre studied twenty trigeminal neuralgia patients who underwent Lidocaine infusion from January 2016 to December 2022. A systematic review of the literature was also undertaken.</p><h3>Results</h3><p>After the first intravenous Lidocaine injection, 16 patients (80%) achieved an efficacy score of III, i.e. they reported pain that had become adequately controlled with their medications. In addition, one patient achieved a BNI score of II and three patients (15%) did not respond to treatment.</p><p>In addition, nine patients (45%) reported reduced pain intensity for more than six months, six patients (30%) for less than three months, and five patients (25%) for three to six months. There were no treatment-related significant adverse events.</p><h3>Conclusion</h3><p>Lidocaine infusion therapy for refractory worsening trigeminal neuralgia is safe and improved pain control when combined with ongoing medical therapy.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12479685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184422","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}