Acta Neurochirurgica最新文献

{"title":"Current evidence on the cell of origin of meningiomas disputes the arachnoid cap cell dogma","authors":"M. Necmettin Pamir,&nbsp;Ayça Erşen-Danyeli,&nbsp;Koray Özduman","doi":"10.1007/s00701-026-06908-1","DOIUrl":"10.1007/s00701-026-06908-1","url":null,"abstract":"<div><h3>Background</h3><p>For over a century, the dominant hypothesis has maintained that meningiomas arise exclusively from arachnoid cap cells. However, emerging evidence from single-cell transcriptomics, spatial sequencing, developmental biology, and transgenic animal models suggests a significantly more complex and heterogeneous cellular origin.</p><h3>Methods</h3><p>This mini-review revisits historical perspectives and critically evaluates the limitations of the traditional arachnoid-based paradigm. By synthesizing classical histological insights with contemporary molecular and proteomic data, the study explores alternative hypotheses, particularly those implicating fibroblast-like or regionally distinct meningeal progenitors.</p><h3>Results</h3><p>The synthesis of multi-omic and developmental data indicates that a singular cellular source is insufficient to account for the clinical and biological diversity of meningiomas. Findings suggest that meningioma ontogeny is likely driven by a broader spectrum of progenitors whose characteristics vary according to anatomical location and embryological lineage.</p><h3>Conclusions</h3><p>A redefinition of meningioma ontogeny is necessary. Future classification and therapeutic strategies should reflect the inherent diversity of their cellular sources and anatomical environments, moving beyond the classical arachnoid-cap-cell model.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06908-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147979884","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":"Elasticity-guided tumor resection: applying biomechanical information to neurosurgical practice","authors":"Jan Saip Aunan-Diop,&nbsp;Bo Halle,&nbsp;Anca Friismose,&nbsp;Christian Bonde Pedersen,&nbsp;Mads Hjortdal Grønhøj,&nbsp;Emi Hojo,&nbsp;Ziying Yin,&nbsp;Christoffer Olsson,&nbsp;Rodrigo Moreno,&nbsp;Bo Mussmann,&nbsp;Frantz Rom Poulsen","doi":"10.1007/s00701-026-06898-0","DOIUrl":"10.1007/s00701-026-06898-0","url":null,"abstract":"<div><p>Tumor stiffness and adhesion are decisive factors in neurosurgical strategy, yet they remain absent from standard planning and navigation. Advances in biomechanics allow these properties to be measured and mapped across modalities: magnetic resonance elastography for preoperative stiffness and adhesion, intraoperative ultrasound elastography for real-time updates, and rheometry as biological ground truth. Emerging frameworks could integrate these measurements with artificial intelligence and multimodal neuroimaging to produce probabilistic maps of tumor consistency and brain–tumor interface quality. We define this concept as elasticity-guided neurosurgery: the incorporation of biomechanical parameters into surgical decision-making to improve safety, efficiency, and personalization. By transforming tactile impressions into actionable data, elasticity-guided neurosurgery could represent a paradigm shift toward more information-driven neurosurgical oncology.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06898-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969514","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":"Treatment-naïve lung cancer presenting with spinal metastases: a national study of survival, surgery, and the role of predictive biomarkers","authors":"Martin Isaksson,&nbsp;Per Andersson,&nbsp;Helena Nyström,&nbsp;Catharina Parai,&nbsp;Pedram Tabatabaei,&nbsp;Olof Westin,&nbsp;Björn Knutsson,&nbsp;Johan Wänman","doi":"10.1007/s00701-026-06914-3","DOIUrl":"10.1007/s00701-026-06914-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Spinal metastasis as the first manifestation of lung cancer, presents challenges in diagnosis, prognosis, and treatment planning. This study aims to evaluate postoperative survival outcomes and to identify prognostic factors in treatment-naïve patients undergoing surgery for spinal metastases, focusing on clinical and molecular variables.</p><h3>Methods</h3><p>This retrospective cohort study included 149 patients who underwent surgery for spinal metastases from lung cancer between 2011 and 2023. Data were obtained from the Swedish National Register for Spine Surgery (Swespine) and the Swedish National Lung Cancer Register (SNLCR). Patients were grouped based on whether spinal metastasis was the initial manifestation of lung cancer or occurred during known disease. Kaplan–Meier analysis and Cox proportional hazards models were used to assess postoperative survival and prognostic factors.</p><h3>Results</h3><p>Of the 149 patients, 114 (77%) presented with spinal metastasis as the initial sign of lung cancer. Median survival in this group was 6 months, compared to 3 months in patients with a prior confirmed lung cancer diagnosis (<i>p</i> = 0.022). In the initial presentation group, longer survival after surgery was observed in patients with predictive biomarkers (8 vs. 5 months, <i>p</i> = 0.003), preserved ambulatory function (8 vs. 3 months, <i>p</i> = 0.002), and better WHO performance status (<i>p</i> &lt; 0.001). In multivariable analysis, biomarker status, WHO performance status, ambulatory function, and age were independently associated with post-operative survival.</p><h3>Conclusion</h3><p>Patients undergoing surgery for spinal metastases as the initial manifestation of lung cancer form a distinct subgroup. Early functional and molecular assessment may improve patient selection and surgical outcome in this population.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13190795/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147969505","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":"Revisiting the facial root exit zone in hemifacial spasm","authors":"Ken Matsushima,&nbsp;Toshio Matsushima,&nbsp;Marc Sindou","doi":"10.1007/s00701-026-06916-1","DOIUrl":"10.1007/s00701-026-06916-1","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13183686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147961756","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 on \"The cuneus vein: initial anatomical description and preservation technique for posterior interhemispheric approaches\"—what defines an anatomic structure?","authors":"Helbert de Oliveira Manduca Palmiero,&nbsp;Eberval Gadelha Figueiredo","doi":"10.1007/s00701-026-06911-6","DOIUrl":"10.1007/s00701-026-06911-6","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06911-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147938469","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":"Pedicled lateral nasal wall flap for endoscopic skull base reconstruction: how I do it","authors":"Zhenhua Huang,&nbsp;Maohua Ding,&nbsp;Yue Ma,&nbsp;Xiaoguang Tong","doi":"10.1007/s00701-026-06906-3","DOIUrl":"10.1007/s00701-026-06906-3","url":null,"abstract":"<div><h3>Background</h3><p>The pedicled nasoseptal flap (Hadad-Bassagasteguy flap, HBF) has been considered as the workhorse for reconstruction of high-flow cerebrospinal fluid (CSF) leak following endoscopic endonasal skull base surgery. However, if the septal mucosa is affected by a tumor or the vascular pedicle is injured due to prior surgery, the use of HBF is precluded.</p><h3>Method</h3><p>We illustrate the harvest techniques of the lateral nasal wall flap (LNWF) based on the posterior lateral nasal artery (PLNA).</p><h3>Conclusion</h3><p>The LNWF is a robust intranasal regional flap with a consistent blood supply and comparable coverage surface, making it a reliable alternative when the HBF is unavailable.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06906-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959553","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: OA-PICA bypass and transcondylar approach for VA fusiform aneurysm","authors":"Kazuhiro Yamamoto,&nbsp;Tsutomu Yoshikane,&nbsp;Kentaro Hayashi","doi":"10.1007/s00701-026-06905-4","DOIUrl":"10.1007/s00701-026-06905-4","url":null,"abstract":"<div><h3>Background</h3><p>Treatment of fusiform vertebral artery aneurysms is demanding because meticulous preservation of perforators and the PICA is required.</p><h3>Methods</h3><p>The occipital artery is mapped with Doppler and harvested by incising the overlying muscle, allowing en-bloc elevation of the musculature. Accurate burr-hole placement minimizes venous sinus injury and reduces the bony defect, while early opening of the foramen magnum improves anatomical orientation and facilitates the bypass technique. The extracranial vertebral artery is safely identified with Doppler before performing OA–PICA bypass and subsequent trapping.</p><h3>Conclusion</h3><p>Standardized steps improve technical reliability and enhance clinical outcomes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06905-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147947525","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":"Cerebrospinal fluid shunt outcomes in patients with idiopathic normal pressure hydrocephalus and an Evans index below 0.3: a prospective study.","authors":"Thanapat Akaraboonlertyot, Ekawut Chankaew, Bunpot Sitthinamsuwan, Theerapol Witthiwej, Luckchai Phonwijit, Prajak Srirabheebhat","doi":"10.1007/s00701-026-06903-6","DOIUrl":"https://doi.org/10.1007/s00701-026-06903-6","url":null,"abstract":"<p><strong>Background: </strong>An Evans index greater than 0.3 is a key diagnostic criterion for idiopathic normal pressure hydrocephalus (iNPH). However, some patients with iNPH symptoms and an Evans index below 0.3 achieve favorable outcomes after cerebrospinal fluid (CSF) shunt surgery. This study aimed to evaluate the clinical and radiographic characteristics and CSF shunt outcomes of these patients.</p><p><strong>Methods: </strong>This prospective study enrolled patients presenting with iNPH symptoms and an Evans index below 0.3. Patients who showed clinical improvement after a spinal tap test underwent CSF shunt placement via ventriculoperitoneal or lumboperitoneal shunting. Outcomes were assessed using subjective tools and symptom-specific scores at baseline and at 3 days, 1 month, 3 months, and 6 months post-surgery.</p><p><strong>Results: </strong>Thirty-five patients with a mean (SD) Evans index of 0.26 (0.02) underwent CSF shunt placement. All clinical domains showed statistically significant improvement at 6 months compared with baseline, except cognition. Subgroup analysis revealed no statistically significant difference in preoperative and final postoperative iNPH grading scale scores between patients undergoing ventriculoperitoneal and lumboperitoneal shunting. One patient experienced shunt overdrainage causing bilateral chronic subdural hematoma that required burr hole craniostomy.</p><p><strong>Conclusions: </strong>These findings suggest that patients with iNPH-like symptoms and an Evans index below 0.3 can benefit from CSF shunt surgery. Multiple assessment tools demonstrated substantial postoperative improvement in this group. In patients with typical iNPH symptoms, a positive spinal tap response, and supportive imaging findings, an iNPH diagnosis is justified regardless of ventricular size. Such patients may be considered surgical candidates for CSF shunt placement.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147961833","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":"Idiopathic normal pressure hydrocephalus: validation of the DESH score in the Capital Region of Denmark","authors":"Bjarni Johannsson,&nbsp;Jan Saip Aunan-Diop,&nbsp;Jonathan Frederik Carlsen,&nbsp;Anika Mai Johannsdottir,&nbsp;Sune Munthe,&nbsp;Frantz Rom Poulsen,&nbsp;Mathias Just Nortvig,&nbsp;Steen Hasselbach,&nbsp;Tina Nørgaard Munch,&nbsp;Christian Bonde Pedersen","doi":"10.1007/s00701-026-06913-4","DOIUrl":"10.1007/s00701-026-06913-4","url":null,"abstract":"<div><h3>Objective</h3><p>Previous research has shown that the Disproportionally Enlarged Subarachnoid-space Hydrocephalus (DESH) score may be a prognostic factor for shunt surgery response for idiopathic normal pressure hydrocephalus (iNPH) patients at 1-month follow-up after shunt surgery. The objective of the current study was external validation in an independent cohort with a longer follow-up period. Secondarily, to assess whether the grading system was confounded by imaging modality.</p><h3>Methods</h3><p>Preoperative baseline characteristics, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans were retrospectively obtained in 127 shunt-operated iNPH patients. Evans’ index, dilation of Sylvian fissures, tight high convexity, focal sulci, callosal angle, and a combination of these radiologic findings (DESH score) were compared according to patients’ response to shunt treatment at a mean follow-up period of 7.4-months. In addition, the data were adjusted for whether grading was performed by MRI or CT.</p><h3>Results</h3><p>Multivariate logistic regression, adjusted for age, sex, and imaging modality, demonstrated a significant association between the DESH score and objective shunt response at follow-up (Odds Ratio 1.35, <i>p</i> = 0.036). Bivariate logistic regression revealed no significant difference in DESH score assessments between CT and MRI. Moreover, including or excluding imaging modality in the multivariate model did not meaningfully alter the regression coefficients.</p><h3>Conclusion</h3><p>Consistent with and supportive of prior findings, the DESH score is associated with shunt response in iNPH patients. No evidence of confounding by imaging modality was identified in this cohort. However, formal equivalence between CT and MRI for DESH scoring remains to be established in studies with paired imaging.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06913-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147925513","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":"Long-term outcomes and lessons learned from treating incidental cerebral aneurysms: a cohort study of 322 patients","authors":"Mathilde Aubertin,&nbsp;Alexis Guédon,&nbsp;Matteo Fantoni,&nbsp;Anne-Laure Bernat,&nbsp;Sébastien Froelich,&nbsp;Marc-Antoine Labeyrie,&nbsp;Francesco Arpaia,&nbsp;Vittorio Civelli,&nbsp;Emmanuel Houdart","doi":"10.1007/s00701-026-06873-9","DOIUrl":"10.1007/s00701-026-06873-9","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the long-term outcomes associated with treating incidental unruptured intracranial aneurysms (UIAs).</p><h3>Materials and methods</h3><p>This retrospective single-center cohort study included 322 patients with 431 UIAs, of which 356 were treated between January 2011 and July 2020. Treatment modalities included coiling, coiling with stenting, clipping, flow diverter stents, and the Woven EndoBridge device. Outcomes were assessed in terms of serious adverse events, recurrence rates, and aneurysm occlusion status based on the modified Raymond-Roy classification (MRRC).</p><h3>Results</h3><p>The mean patient age was 53.1 years, with a predominance of females (71%). Most aneurysms (95%) were located in the anterior circulation. Clinical and radiological follow-up continued through May 2024 with a mean follow-up of 48.1 months. The perioperative complication rate was 7.0%, with 1.4% of patients experiencing permanent disability at 90 days. Late complications (occurring more than 12 months post-treatment) included one fatal stent thrombosis and one fatal aneurysmal rupture. Additionally, one patient suffered a subarachnoid hemorrhage (SAH) due to a de novo aneurysm, and another bled from a known but untreated aneurysm. The annual non-aneurysmal mortality rate was 0.97%. Recanalization occurred in 20% of aneurysms treated with coils. Seven patients (2.2%) were lost to follow-up.</p><h3>Conclusion</h3><p>Treatment of UIAs may be associated with very late complications, including delayed rupture. Approximately 20% of aneurysms treated with coils recanalized, necessitating long-term imaging surveillance. Non-aneurysmal mortality in this population is also non-negligible. These findings highlight the need for long-term evaluation of UIA treatment outcomes, ideally over a minimum follow-up period of five years.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06873-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147872931","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}