Acta Neurochirurgica最新文献

{"title":"Complications after Gamma Knife Radiosurgery for Brain AVMs: Predictive factors for symptomatic radionecrosis","authors":"Popadic Branko,&nbsp;Amedeo Cervo,&nbsp;Antonio Macera,&nbsp;Guglielmo Pero,&nbsp;Giada Valente,&nbsp;Florian Scheichel,&nbsp;Camillo Sherif,&nbsp;Marco Picano,&nbsp;Marco Cenzato,&nbsp;Alessandro La Camera,&nbsp;Mariangela Piano","doi":"10.1007/s00701-025-06532-5","DOIUrl":"10.1007/s00701-025-06532-5","url":null,"abstract":"<div><h3>Purpose</h3><p>The aim of this study is to investigate complications after Gamma Knife Radiosurgery (GKRS) for AVMs and predictive factors for symptomatic radionecrosis.</p><h3>Methods</h3><p>A retrospective single centre study on AVMs treated with GKRS between 2008 and 2016 was performed.</p><h3>Results</h3><p>A total of 209 patients were included. AVM obliteration was seen in 70%, while radiation induced changes (RIC) were detected in 45%. Symptomatic radionecrosis was found in 13 patients (6.2%). Furthermore, 12 patients (5.7%) experienced latent period haemorrhage. Predictors of symptomatic radionecrosis were 12 Gy volume (<i>p</i> = 0.007), RIC grade (<i>p</i> =  &lt; 0.0001) and ≥ 2 endovascular treatments (<i>p</i> = 0.001) in univariate analysis, while age (<i>p</i> = 0.043), RIC grade (<i>p</i> = 0.0002) and ≥ 2 endovascular procedures (<i>p</i> = 0.002) were identified in multivariate analysis.</p><h3>Conclusion</h3><p>Complication after GKRS for AVMs were latent period haemorrhage in 5.7% and symptomatic radionecrosis in 6.2%. Age, RIC grade and ≥ 2 endovascular procedures were risk factors for symptomatic radionecrosis. Due to the unclear benefits of endovascular procedures in addition to GRKS and its potential negative effects, the indication for endovascular treatment should be weighed carefully.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06532-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861411","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":"Combined exoscopic and endoscopic oblique approach to parafalx lesions while preserving normal structures via the interhemispheric fissure: How I do it","authors":"Toshiaki Inomo,&nbsp;Eiji Ito,&nbsp;Mao Yokota,&nbsp;Tadashi Watanabe","doi":"10.1007/s00701-025-06529-0","DOIUrl":"10.1007/s00701-025-06529-0","url":null,"abstract":"<div><h3>Background</h3><p>When treating parafalx lesions, the bridging veins or the frontal sinuses can sometimes obstruct access. Preserving these structures to avoid surgical complications is preferred.</p><h3>Methods</h3><p>We described the concept of the selective interhemispheric oblique approach (SIOA), which combines exoscopic and endoscopic visualization with gravity-assisted brain retraction to ensure safe access to the parafalx lesions.</p><h3>Conclusions</h3><p>The SIOA is a precise and versatile technique for treating parafalx lesions, particularly in anatomically complex areas. With this approach, it’s possible to mitigate risk of venous injury or sinus opening, avoid the retraction of eloquent areas, and obtain excellent surgical outcomes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06529-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143861412","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":"Emerging strategies for the prediction of behaviour, growth, and treatment response in vestibular schwannoma","authors":"Daniel Lewis,&nbsp;Ka-loh Li,&nbsp;Ibrahim Djoukhadar,&nbsp;Cathal J. Hannan,&nbsp;Omar N. Pathmanaban,&nbsp;David J. Coope,&nbsp;Andrew T. King","doi":"10.1007/s00701-025-06522-7","DOIUrl":"10.1007/s00701-025-06522-7","url":null,"abstract":"<p>Vestibular schwannoma (VS) can present several management challenges for the clinician. Their unpredictable potential for growth creates uncertainty regarding when active treatment should be initiated, and once growth is confirmed which treatment option should be adopted, notably surgery or radiotherapy, and in particular stereotactic radiosurgery (SRS). The obvious benefits of SRS would ideally come with the ability to reliably predict long-term radiosurgery response/failure. Differentiation from temporary post-treatment phenomena such as transient tumour expansion or reactive swelling remains an unmet need. More powerful again would be the pre-treatment identification of which tumours will respond to radiosurgery and which will not. Over the past decade, there has been emerging interest in the development of non-invasive biomarkers, including imaging, for predicting growth and treatment response in VS. Alongside clinical radiographic predictors for VS growth such as extracanalicular tumour location and growth in the first year, studies have shown potential promise for advanced MRI and blood-based biomarkers that capture pathophysiological mechanism behind VS growth. Emerging interest in <i>radiomics</i>-based analyses of routinely acquired MRI, and the use of physiological imaging techniques such as dynamic-contrast enhanced MRI for pre- and post-treatment evaluation of tumour microvasculature and microstructure holds promise for revolutionizing this area. This article explores the current state of identifying VS growth at initial presentation, predicting treatment response to SRS and detecting early treatment failure, and finally the potential for developing more personalized patient selection for drug therapies, including bevacizumab, as well as emerging novel therapeutics for these tumours.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06522-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856554","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":"Factors associated with local failure after stereotactic radiation to the surgical bed of patients with a single breast cancer metastasis","authors":"Ory Haisraely,&nbsp;Marcia L. Jaffe,&nbsp;Yaacov R Lawrence,&nbsp;Zvi Symon,&nbsp;Anton Whol,&nbsp;Thaila Kaisman-Elbaz,&nbsp;Zvi R Cohen,&nbsp;Alicia Taliansky,&nbsp;Orit Kaidar-Person","doi":"10.1007/s00701-025-06520-9","DOIUrl":"10.1007/s00701-025-06520-9","url":null,"abstract":"<div><h3>Introduction</h3><p>Breast cancer brain metastases (BCBM) are increasingly common due to improved systemic therapies prolonging survival. This study evaluates local control and factors influencing outcomes in patients with resected BCBM treated with postoperative stereotactic radiotherapy (SRT).</p><h3>Methods</h3><p>A retrospective review included single resected BCBM treated with postoperative SRT from 2010 to 2022. The median follow-up was 28 months (range, 14–43). Variables analyzed included tumor size, biology, surgical corridor inclusion, radiation dose, and timing of SRT. Multivariable analysis was conducted using Cox regression.</p><h3>Results</h3><p>62 patients were analyzed in multivariable analysis, HER2-positive status was associated with improved local control (HR: 0.76, 95% CI: 0.36–0.88, p = 0.032), as was a higher biologically effective dose (BED &gt; 40 Gy, HR: 0.65, 95% CI: 0.45–0.89, p = 0.028). In contrast, tumor size &gt; 5 cm (HR: 2.1, 95% CI: 1.7–4.6, p = 0.021) and delayed initiation of SRT beyond 28 days post-surgery (HR: 2.7, 95% CI: 1.9–4.7, p = 0.015) were associated with worse outcomes. Age, cystic metastases, inclusion of surgical corridor, and tumor location were not significantly related to local control. Radiation necrosis occurred in 13% of patients, predominantly asymptomatic.</p><h3>Conclusion</h3><p>Postoperative SRT provides effective local control in resected BCBM. In multivariable analysis, HER2 positivity, higher BED, and timely SRT significantly influenced outcomes, while larger tumor size and delayed treatment were negative prognostic factors. Future research should optimize dosimetric strategies and integrate systemic therapy to improve local and intracranial control.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06520-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856415","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 vasa corona ruptured pseudoaneurysm: case report and review of literature","authors":"Hikaru Nakamura,&nbsp;Tsuyoshi Izumo,&nbsp;Kazuaki Okamura,&nbsp;Shota Yoshimura,&nbsp;Nozomi Ueki,&nbsp;Shiro Baba,&nbsp;Kenta Ujifuku,&nbsp;Yoichi Morofuji,&nbsp;Takeshi Hiu,&nbsp;Koichi Yoshida,&nbsp;Takayuki Matsuo","doi":"10.1007/s00701-025-06531-6","DOIUrl":"10.1007/s00701-025-06531-6","url":null,"abstract":"<div><p>Ruptured aneurysms or pseudoaneurysms associated with the vasa corona, in the absence of cerebral arteriovenous malformation or dural arteriovenous fistula, are extremely rare but should be recognized as a possible cause of subarachnoid hemorrhage (SAH). We report the case of a 51-year-old female who presented with SAH due to a ruptured vasa corona pseudoaneurysm, with no associated anatomical abnormalities involving the vertebral artery or the posterior inferior cerebellar artery. She recovered after direct surgery. In previous cases, anterior spinal artery dilatation due to posterior inferior cerebellar artery anomalies prompted endovascular treatment. A thorough assessment remains crucial, and direct surgery can be effective.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06531-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856536","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":"Transplanum polare approach to the anterior mesiotemporal region","authors":"Daniele Starnoni,&nbsp;Lorenzo Giammattei,&nbsp;Roy T. Daniel,&nbsp;Pablo González-López","doi":"10.1007/s00701-025-06530-7","DOIUrl":"10.1007/s00701-025-06530-7","url":null,"abstract":"<div><h3>Background</h3><p>The transplanum polare approach is a surgical technique targeting mesiotemporal structures, such as the amygdala and hippocampus. It offers a safer alternative to transcortical and transsylvian routes, reducing risks to white matter tracts, optic radiations, and vascular structures.</p><h3>Method</h3><p>This method involves a pterional craniotomy with tailored sylvian fissure dissection to access the planum polare. Dynamic retraction, image guidance, and subpial dissection ensure precise resection while preserving critical neural and vascular anatomy.</p><h3>Conclusion</h3><p>By minimizing disruption and technical complexity, the transplanum polare approach enhances safety and efficacy, reducing complications and improving outcomes for patients with mesiotemporal lesions.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06530-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856555","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":"Association between triglyceride-glucose index and risk of acute kidney injury in patients with aneurysmal subarachnoid hemorrhage","authors":"Xingyu Qiu,&nbsp;Yu Zhang,&nbsp;Jialing He,&nbsp;Renjie Zhang,&nbsp;Dingke Wen,&nbsp;Xing Wang,&nbsp;Chao You,&nbsp;Fang Fang,&nbsp;Lu Ma","doi":"10.1007/s00701-025-06533-4","DOIUrl":"10.1007/s00701-025-06533-4","url":null,"abstract":"<div><h3>Purpose</h3><p>This study aimed to investigate the association between the triglyceride-glucose (TyG) index and the risk of acute kidney injury (AKI) in patients with aneurysmal subarachnoid hemorrhage (aSAH).</p><h3>Methods</h3><p>This retrospective cohort study included aSAH patients in West China Hospital. The TyG index was calculated as ln[fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. The primary outcome was AKI within 7 days of admission, and secondary outcomes included hospital, 90-day, and 180-day mortality. Multivariate logistic regression and Cox proportional hazards models were used to adjust for potential confounders. The association between the TyG index and AKI was also assessed with restricted cubic spline analysis. A predictive logistic model for AKI risk was developed and its performance was assessed using the area under the receiver operating characteristic curve, calibration correction curves, and decision curve analysis. Based on the optimal model, an online Shiny R application was developed.</p><h3>Results</h3><p>A total of 3271 patients with aneurysmal subarachnoid hemorrhage were included. AKI occurred in 156 patients (4.7%), with the incidence significantly increasing across TyG index quartiles (Q1: 2.7%, Q4: 8.6%; <i>P</i> for trend &lt; 0.001). Each 1-unit increase in TyG index was associated with an 90% higher odds of AKI (OR 1.90, 95% CI 1.48–2.45). Mortality rates also increased with higher TyG quartiles: hospital mortality (HR 1.30, 95% CI 1.05–1.62), 90-day mortality (HR 1.20, 95% CI 1.03–1.39), and 180-day mortality (HR 1.18, 95% CI 1.02–1.37). Kaplan–Meier analysis revealed reduced survival in higher TyG quartiles (Log-rank <i>P</i> &lt; 0.001). Subgroup analyses confirmed consistent associations across demographics characteristics and treatment modalities. Incorporating the TyG index into risk models improves their discriminatory power and calibration. A Shiny application based on this model is freely accessible at (https://asahaki.shinyapps.io/asahaki/).</p><h3>Conclusion</h3><p>The TyG index is an independent predictor of AKI and mortality in aSAH patients. Its incorporation into clinical assessment facilitates early risk stratification and individualized management.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06533-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856590","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 association between allergy and risk of brain tumors: Evidence from 40 observational studies","authors":"Zhihua Pan,&nbsp;Senxin Zhang,&nbsp;Siyi Cen,&nbsp;Chongxian Hou,&nbsp;Maoxiang Li,&nbsp;Jing’an Ye,&nbsp;Jiliang Hu","doi":"10.1007/s00701-025-06499-3","DOIUrl":"10.1007/s00701-025-06499-3","url":null,"abstract":"<div><h3>Purpose</h3><p>The potential association between the medical history of allergic conditions and brain tumors have been investigated. However, the agreement has not been reached. The aim of this meta-analysis was to explore the possible association between allergic disease and brain tumor risk.</p><h3>Methods</h3><p>A comprehensive search was conducted and eligible studies were identified. Random-effects model was applied to meta-analyze the data.</p><h3>Results</h3><p>In accordance with the retrieval strategy, 40 articles with 31 case–control studies and 9 cohort studies were enrolled in the present meta-analysis. The results suggested that history of allergy was associated with a decreased risk of brain tumor (OR 0.78, 95% CI 0.71–0.86). Compared to individuals with 1 allergic condition (OR 0.78, 95% CI 0.71–0.85), those with at least 2 allergic conditions (OR 0.65, 95% CI 0.58–0.73) may have a potentially lower brain tumor risk. Moreover, decreased brain tumor risk was found in both adults (OR 0.75, 95% CI 0.69–0.81) and children/adolescents (OR 0.78, 95% CI 0.62–0.97). Allergy history is associated with a decreased risk of glioma (OR 0.71. 95% CI 0.61–0.81). Besides, glioma risk is negatively associated with asthma (OR 0.82, 95% CI 0.74–0.91) and eczema (OR 0.84, 95% CI 0.72–0.98). There is a tendency that allergy is associated with decreased risk of meningioma (OR 0.89, 95% CI 0.74–1.07).</p><h3>Conclusions</h3><p>Allergy should be considered as a protective factor for brain tumors, especially glioma. Further prospective cohort studies are needed to provide a higher level of evidence.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06499-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856587","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":"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}