Acta Neurochirurgica最新文献

{"title":"Selective subperineurial dissection in vestibular schwannoma surgery: how I do it","authors":"Taichi Sayanagi,&nbsp;Ryota Tamura,&nbsp;Takayuki Ohira,&nbsp;Masahiro Toda","doi":"10.1007/s00701-026-06919-y","DOIUrl":"10.1007/s00701-026-06919-y","url":null,"abstract":"<div><h3>Background</h3><p>The dissection plane in vestibular schwannoma surgery significantly influences facial and cochlear nerve outcomes. Although histological studies demonstrate that the \"tumor capsule\" represents vestibular nerve perineurium, epicapsular dissection along its outer surface remains prevalent in clinical practice.</p><h3>Method</h3><p>We describe subperineurial dissection, removing tumor from beneath the perineurium while preserving this protective layer on the facial and cochlear nerves. Key steps include early internal auditory canal drilling and identification of the true perineurial plane.</p><h3>Conclusion</h3><p>Subperineurial dissection prioritizes nerve function over radical resection, achieving high rates of facial nerve preservation with acceptable tumor control.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004369","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 quality of life in adult craniopharyngioma patients: correlation with pituitary stalk section after endoscopic endonasal surgery","authors":"Irene Portonero,&nbsp;Enrico Lo Bue,&nbsp;Alessandro Pesaresi,&nbsp;Alice Antico,&nbsp;Silvia Sgambetterra,&nbsp;Raffaele De Marco,&nbsp;Federica Penner,&nbsp;Diego Garbossa,&nbsp;Michele M. R. Lanotte,&nbsp;Francesco Zenga","doi":"10.1007/s00701-026-06902-7","DOIUrl":"10.1007/s00701-026-06902-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Craniopharyngiomas are benign but locally aggressive tumors whose surgical treatment poses a challenge due to their proximity to critical structures. While gross total resection (GTR) may reduce recurrence risk, it often leads to significant long-term morbidity, especially when the pituitary stalk is sacrificed. This study aims to assess health-related quality of life (QoL) in adult patients undergoing endoscopic endonasal approach (EEA) for craniopharyngioma, with a focus on the impact of pituitary stalk section.</p><h3>Methods</h3><p>We retrospectively analyzed 35 adult patients who underwent EEA for histologically confirmed craniopharyngioma between April 2012 and September 2023. Inclusion criteria were age &gt; 18 years and at least one year of follow-up. Patients completed a custom 8-item telephone questionnaire assessing the impact of hormone replacement therapy (HRT), visual changes, hypothalamic dysfunction (sleep, appetite, sexual and behavioral disturbances), and nasal or olfactory symptoms. Each item was rated on a 1–5 scale, and patients identified the most burdensome symptom.</p><h3>Results</h3><p>Older patients (&gt; 55 years), those without preoperative panhypopituitarism, and those with postoperative hormonal decline reported higher impact. Visual deficits significantly affected QoL, particularly when vision worsened postoperatively. Obese patients (BMI &gt; 30) reported greater impact from weight gain. Sleep disturbances were more prevalent in adamantinomatous craniopharyngiomas, while behavioral changes were more frequent in older patients. Smokers reported more nasal breathing issues. Sexual dysfunction was more frequently reported by males, older patients, and those who had stalk resection or new endocrine deficits. Stalk section was significantly associated with higher GTR rates but also with worsened endocrine function and higher cumulative QoL burden.</p><h3>Conclusions</h3><p>Pituitary stalk resection increases GTR likelihood but at the cost of greater long-term endocrine morbidity. Patient age and baseline function significantly influence postoperative QoL, underscoring the importance of individualized surgical planning.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13385088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986236","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":"Minimally invasive versus burr hole craniostomy for chronic subdural haematoma evacuation: a systematic review and meta-analysis","authors":"Shaan Patel,&nbsp;Shiva A. Nischal,&nbsp;Angelette Mendonca,&nbsp;Kush M. Kale,&nbsp;Santosh Guru,&nbsp;Pious D. Patel,&nbsp;Kevin Hines,&nbsp;Jack Jallo,&nbsp;Srinivas K. Prasad","doi":"10.1007/s00701-026-06912-5","DOIUrl":"10.1007/s00701-026-06912-5","url":null,"abstract":"<div><h3>Background</h3><p>Minimally invasive surgery (MIS) has emerged as an appealing alternative to burr hole craniostomy (BHC) for chronic subdural haematoma (cSDH), offering reduced operative trauma and anaesthetic exposure. However, whether these procedural advantages translate into comparable outcomes remains uncertain. This systematic review and meta-analysis aimed to compare the safety, effectiveness, and procedural performance of MIS versus BHC for cSDH evacuation, with attention to device-specific outcomes.</p><h3>Methods</h3><p>A systematic search of PubMed, Embase, and CENTRAL (10th November 2025) identified randomised and observational studies directly comparing MIS techniques, including twist-drill craniostomy (TDC), subdural evacuating port systems (SEPS), and YL-1 devices, with BHC. Primary outcomes were reoperation, recurrence, and overall complications. Secondary outcomes included mortality, clinical, and functional recovery, operative time (OT), and length of hospital stay (LOS). Random-effects meta-analysis using REML generated pooled risks ratios (RRs) and mean differences (MDs). Quality and risk of bias was assessed using RoB 2, ROBINS-I, and GRADE.</p><h3>Results</h3><p>Twenty-seven studies encompassing 3752 patients (MIS 1763; BHC 1989) met inclusion criteria. MIS was associated with significantly higher reoperation risk (18.3% versus 10.2%; RR 1.57; 95% CI 1.17–2.10; <i>P</i> &lt; 0.001) and higher recurrence in SEPS-specific analyses (RR 1.73; 95% CI 1.29–2.32). Overall complications were lower with MIS (RR 0.63, 95% CI 0.42–0.94; <i>P</i> &lt; 0.05). Mortality and postoperative functional outcomes were comparable between groups. MIS substantially reduced OT (MD -24.5 min; <i>P</i> &lt; 0.001) and LOS (MD -1.97 days; <i>P</i> &lt; 0.01). Device-level heterogeneity was marked: SEPS demonstrated poorest durability, whereas YL-1 systems showed lowest complication risk. RCT-specific subgroup analyses demonstrated directional consistency with the main effect for all primary outcomes. Risk of bias was moderate to serious for most included studies, with moderate certainty of evidence.</p><h3>Conclusions</h3><p>MIS offers meaningful perioperative advantages but at the cost of reduced durability, particularly for SEPS-based drainage. BHC remains the more definitive intervention for cSDH, although MIS retains an important role in carefully selected patents, particularly where minimising procedural burden or perioperative morbidity is prioritised. Device-specific performance and haematoma morphology should guide surgical strategy as the field moves toward more mechanistically informed, patient-centred care.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06912-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986252","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":"Imaging-based predictors of progression in brain abscess: the role of loculation and ADC gradient","authors":"Jong-Young Park,&nbsp;Dong-Won Shin,&nbsp;Kawngwoo Park,&nbsp;Eun Young Kim,&nbsp;Chan Jong You,&nbsp;Gi-Taek Yee","doi":"10.1007/s00701-026-06915-2","DOIUrl":"10.1007/s00701-026-06915-2","url":null,"abstract":"<div><h3>Purpose</h3><p>Brain abscess remains a life-threatening condition despite advances in neurosurgical and antimicrobial therapy, and reliable imaging-based markers to guide postoperative risk stratification and surveillance remain limited. This study aimed to identify clinical and radiographic factors associated with abscess progression in neurosurgically treated patients, with particular emphasis on the apparent diffusion coefficient (ADC) gradient.</p><h3>Methods</h3><p>We retrospectively reviewed 53 patients with brain abscess who underwent neurosurgical treatment at Gachon University Gil Medical Center between January 2005 and April 2025. Clinical characteristics, microbiology, surgical approach, and imaging findings were analyzed. Univariable and multivariable logistic regression analyses were performed to identify factors associated with progression. ADC gradients were evaluated as continuous variables and dichotomized using a receiver operating characteristic (ROC)–derived cutoff.</p><h3>Results</h3><p>The cohort included 38 men and 15 women, with a median age of 56.4 years. During a mean follow-up of 28.0 months, progression occurred in 17 patients (32%). Abscess loculation was significantly associated with progression in univariable analysis. Absolute ADC values at baseline or during follow-up were not predictive. ROC analysis demonstrated good discriminatory performance of the ADC gradient (AUC 0.857), with higher gradients associated with a significantly reduced risk of progression. The ADC gradient remained independently associated with progression in multivariable analysis.</p><h3>Conclusion</h3><p>Abscess loculation and the ADC gradient are radiographic features associated with progression in surgically managed brain abscess and may serve as useful imaging markers for clinical monitoring. Incorporation of ADC gradient assessment into postoperative imaging surveillance may help identify cases with a higher likelihood of treatment resistance and support clinical decision-making. However, these findings should be interpreted with caution given the retrospective and single-center design of the study, and further validation in prospective multicenter cohorts is needed.</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/s00701-026-06915-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986183","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":"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}