Acta Neurochirurgica最新文献

{"title":"Robot-assisted deep brain stimulation with intraoperative CT imaging and frameless registration module: a new gold-standard?","authors":"Gonzague Defrance, Philippe Domenech, Johan Pallud, Marc Zanello","doi":"10.1007/s00701-025-06581-w","DOIUrl":"10.1007/s00701-025-06581-w","url":null,"abstract":"<p><strong>Background: </strong>Although stereotactic frame-based techniques remain widely used for deep brain stimulation (DBS) implantation, robot-assisted procedures have demonstrated improved accuracy, enhanced precision, and reduced operative time. Our team has over two decades of experience in robot-assisted surgery and intraoperative imaging.</p><p><strong>Method: </strong>We detail our current surgical workflow for DBS implantation, combining the Neuromate robot (Renishaw), the NeuroLocate frameless registration module, and intraoperative cone-beam CT imaging using the O-Arm system (Medtronic).</p><p><strong>Conclusion: </strong>This approach provides a safe, efficient, and reproducible alternative to traditional methods, supporting its broader adoption in modern functional neurosurgery.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"168"},"PeriodicalIF":1.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281956","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":"Middle meningeal artery embolization for chronic subdural hematoma: meta-analysis of three randomized controlled trials and review of ongoing trials.","authors":"Conor S Gillespie, Munashe Veremu, William H Cook, Mohammad Ashraf, Keng Siang Lee, Youssef Chedid, Ali M Alam, Yevgeny Karepov, Benjamin M Davies, Ellie Edlmann, Panagiotis Papanagiotou, Stefanos Korfias, Thomas Santarius, Thais Minett, Peter J Hutchinson, Angelos Kolias","doi":"10.1007/s00701-025-06587-4","DOIUrl":"10.1007/s00701-025-06587-4","url":null,"abstract":"<p><strong>Background: </strong>Middle Meningeal Artery Embolization (MMAE) has been proposed as adjunct and stand-alone treatment for Chronic Subdural Hematoma (CSDH). We aimed to meta-analyze three recently published randomized controlled trials, to reliably estimate the effect of MMAE. We also carried out a systematic review of ongoing trials and their key outcomes.</p><p><strong>Methods: </strong>A PRISMA-compliant meta-analysis was conducted (PROSPERO ID CRD42024618816). Three published RCTs (MAGIC-MT, EMBOLISE, and STEM) assessing MMAE in CSDH were included. Trial primary outcomes were pooled for analysis using random effects models. Primary and secondary outcomes (recurrence/surgical rescue, functional outcome) were obtained, stratified by treatment group (undergoing surgery, and nonsurgical management). A descriptive review of trials in public registries was also conducted (search date 30th November 2024).</p><p><strong>Results: </strong>In total, 1432 patients were included from three trials in meta-analysis. Overall, MMAE reduced symptomatic progression or recurrence, but was not statistically significant (RR 0.50, 95% CI 0.23-1.06, P = 0.058). For the group undergoing surgery, MMAE was not associated with reduced recurrence (RR 0.60, 95% CI 0.19-1.88, P = 0.194). For nonsurgical management, MMAE reduced progression (RR 0.36, 95% CI 0.22-0.60, P < 0.001). MMAE did not influence functional outcome (RR 1.01, 95% CI 0.97-1.04, P = 0.790). From the literature search, there are twenty-one registered trials. Nineteen studies include arms assessing MMAE as an adjunct to surgery, eleven compare MMAE to observation, and four with surgery. The most common primary outcome is recurrence (47.8%, N = 11), either radiologically, or requiring a second surgery. Inclusion criteria, embolization agents, primary and secondary outcomes differed significantly between studies.</p><p><strong>Conclusions: </strong>In this meta-analysis of three randomized controlled trials, the use of MMAE in patients undergoing surgery did not appear to significantly reduce recurrence or improve functional outcomes, but did reduce progression in nonsurgical cohorts. Further studies assessing these cohorts are ongoing.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"166"},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257091","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 use of lateral spread response measurement in the upper orbicularis oculi and mandibular muscles in patients with hemifacial spasm after botulinum toxin treatment.","authors":"Yuki Amano, Bunsho Asayama, Shusaku Noro, Takenori Abe, Masahiro Okuma, Ryota Nomura, Kaori Honjo, Yoshinobu Seo, Hirohiko Nakamura","doi":"10.1007/s00701-025-06570-z","DOIUrl":"10.1007/s00701-025-06570-z","url":null,"abstract":"<p><strong>Background: </strong>Following repeated botulinum toxin (BTX) treatments, patients with hemifacial spasm (HFS) are recommended to undergo microvascular decompression (MVD) for a permanent cure. Intraoperative lateral spread response (LSR) monitoring is important to improve surgical outcomes. However, LSR monitoring during MVD surgery in HFS patients who have previously received BTX is challenging, since the muscles typically used to assess the LSR are paralyzed. Here, we describe our use of the upper part of the orbicularis oculi and mentalis muscles for intraoperative monitoring of the LSR during MVD in HFS patients following BTX treatment.</p><p><strong>Methods: </strong>HFS patients who underwent MVD surgery were divided into two groups based on their history of BTX treatment: BTX+ and BTX- groups. In the BTX+ group, MVD was performed at least 3 months after the last BTX injection. We measured LSR morphology, including the number of spikes, their duration, and maximum amplitude in all patients. We also measured intraoperative LSR disappearance rate, and the cure rate of HFS at the final follow-up (over 1 year after surgery).</p><p><strong>Results: </strong>Although the waveforms showed a trend toward shorter durations with mandibular branch stimulation in the BTX+ group, there was no difference in the number of spikes or maximum amplitude values. There was no increase in LSR dysmetria after BTX treatment (BTX+ group: 32.8% vs. BTX- group: 31.9%). There was also no difference in intraoperative LSR disappearance rate between the two groups (BTX+ group: 68.3% vs. BTX- group: 74.6%).</p><p><strong>Conclusion: </strong>Intraoperative LSR monitoring using the upper part of the orbicularis oculi muscle and the mentalis muscle at an interval of at least 3 months after the last BTX treatment might be a feasible monitoring technique during MVD for HFS.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"167"},"PeriodicalIF":1.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12152068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257090","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":"3D-exoscopic extradural Hakuba-Dolenc approach with manipulation of pneumatized anterior clinoid process for the prevention of cerebrospinal fluid leakage: how I do it.","authors":"Long Wang, Wenlong Tang, Ao Pei, Dong Zhang","doi":"10.1007/s00701-025-06583-8","DOIUrl":"10.1007/s00701-025-06583-8","url":null,"abstract":"<p><strong>Background: </strong>Microsurgical skull base technique continues to be a crucial component in repairing intracranial vascular anomalies and resecting massive lesions.</p><p><strong>Methods: </strong>We described a technical modification to manipulate pneumatized anterior clinoid process (pACP) during extradural Hakuba-Dolenc approach for the precaution of postoperative cerebrofluid leakage under the direct visualization of 3D digital Aeos exoscope. The interdural dissection of lateral wall of cavernous sinus followed by ACP removal using hybrid (drilling & biting) technique was performed. A supplemental video of surgical details was also presented.</p><p><strong>Conclusions: </strong>The hybrid clinoidectomy technique has been shown to be an effective method for preventing cerebrospinal fluid leakage, particularly during surgical manipulations involving pneumatized skull base bone.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"165"},"PeriodicalIF":1.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245714","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":"What happens to conservatively managed chronic subdural haematoma.","authors":"Jack Read, Ellie Edlmann","doi":"10.1007/s00701-025-06577-6","DOIUrl":"10.1007/s00701-025-06577-6","url":null,"abstract":"<p><strong>Background: </strong>Chronic subdural haematoma (CSDH) is a common neurosurgical problem, increasingly prevalent due to an ageing population. Conservative management is an option for asymptomatic or mild cases, though data on outcomes is limited.</p><p><strong>Aim/objective: </strong>This study aims to address critical gaps in understanding around conservatively managedCSDH and whether there are features that can predict progression and the longer-term prognosis of these patients.</p><p><strong>Methods: </strong>A retrospective cohort study was performed at a major trauma centre in the UK. All patients with chronic subdural haematoma referred from March 2019 to March 2021 were included and grouped into surgical or conservative management. Demographic, outcome, and radiological data were collected from patient records and compared.</p><p><strong>Results: </strong>Of 289 patients, 90 had surgery and 199 were managed conservatively. Conservative patients were older (84 vs 77 years, p < 0.0001), had more comorbidities (4 vs 2, p < 0.0001), higher frailty (CFS > 6: 45% vs 10%, p < 0.0001), and greater anti-thrombotic use (57% vs 42%, p = 0.0175). Mortality was significantly higher in the conservative group at all time points including one month (16% vs 2%, p < 0.0001), one year (42% vs 12%, p < 0.0001) and two years (55% vs 21%, P < 0.0001). Surgical patients had significantly greater midline shift (10 mm vs 2.6 mm, p < 0.0001), and haematoma depth (24 mm vs 11 mm, p < 0.0001). Only 3% of conservative patients crossed over to surgery.</p><p><strong>Conclusion: </strong>Our study highlights the high mortality rate in conservatively managed CSDH, with frailty as a key indicator for early death. The low crossover to surgery questions the necessity of radiological monitoring in conservatively managed CSDH.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"164"},"PeriodicalIF":1.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12145291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245715","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":"Advancing frameless stereotactic navigation for precise targeting of the foramen ovale during radio-frequency thermal ablation (RFTA) for trigeminal neuralgia in anesthetized patients using triggered electromyography.","authors":"Justin W Silverstein, Alon Kashanian, Grace Huang, Jason A Ellis","doi":"10.1007/s00701-025-06575-8","DOIUrl":"10.1007/s00701-025-06575-8","url":null,"abstract":"<p><strong>Purpose: </strong>Radio-frequency thermal ablation (RFTA) is an effective method for treating trigeminal neuralgia (TN). However, challenges persist in locating the foramen ovale (FO) and awake surgery has its limitations. Here we evaluate a novel neurophysiologic technique using dynamic mapping with triggered electromyography (T-EMG) to guide surgeons in identifying the FO under general anesthesia.</p><p><strong>Methods: </strong>We prospectively collected clinical data from all patients undergoing RFTA for TN with dynamic T-EMG between September 2022 and December 2024. We subsequently reviewed the data within this database. We placed needle electrodes in the masseter muscle and converted a Tew trigeminal needle to a monopolar stimulator. With the assistance of stereotactic navigation and fluoroscopy, we guided the needle to the predicted border of the FO and delivered a current until a response was elicited by the masseter muscle. Based on this motor response, we made real-time trajectory adjustments to identify the FO and ablate the appropriate trigeminal branch.</p><p><strong>Results: </strong>Twenty-six consecutive patients underwent 27 RFTA procedures under general anesthesia. In 26 out of 27 procedures (96%), the FO was successfully identified. All patients awoke with intact mastication functionality. Sixteen patients (61.5%) had improvement in their facial pain, two (7.7%) had worse pain, and eight (30.8%) had no change in their pain at last follow-up. There were no major complications.</p><p><strong>Conclusion: </strong>Dynamic mapping using T-EMG for identifying the V3 motor branch of the trigeminal nerve during RFTA procedures under general anesthesia is a reliable and practical method for identifying the FO. This technique demonstrates the potential to enhance the precision of RFTA and improve patient outcomes.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"162"},"PeriodicalIF":1.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223959","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":"Prognostic factors after salvage resection for local progression of brain metastases after radiotherapy.","authors":"Hideyuki Arita, Toshiki Ikawa, Naoyuki Kanayama, Masahiro Morimoto, Toru Umehara, Hidenori Yoshizawa, Yoshinori Kodama, Yoshiko Okita, Manabu Kinoshita, Koji Konishi","doi":"10.1007/s00701-025-06578-5","DOIUrl":"10.1007/s00701-025-06578-5","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in cancer treatment have prolonged survival after the onset of brain metastasis (BM), increasing the incidence of local progression (LP) following radiotherapy. However, no standard approach exists for managing LP. We aimed to evaluate the outcomes of salvage surgery in a clinical setting.</p><p><strong>Methods: </strong>The clinical data were retrospectively collected from the medical records of 49 patients who underwent their first salvage surgery for LP of BM at a single institution between April 2014 and March 2024. Overall survival (OS) and LP-free survival (LPFS) were evaluated using the Kaplan-Meier method.</p><p><strong>Results: </strong>Most patients (47/49, 96%) had a history of stereotactic radiosurgery (n = 34) and/or stereotactic radiotherapy (n = 14). The histopathological examination of surgical specimens confirmed tumor recurrence in 33 patients and radiation necrosis (RN) in 16 patients. The interval from prior radiotherapy to salvage surgery was longer in patients with RN than in those with recurrence (median: 42.3 vs. 9.3 months, respectively). OS was longer in the RN group compared with the recurrent group (median: 68.5 months and 21.8 months, respectively). In the recurrent group, shorter OS was associated with preoperative poor KPS (< 70), the presence of active extracranial lesions, and RPA classes 2-3. The extent of resection, postoperative chemotherapy, and local irradiation had no significant effect on OS. After salvage surgery, further LP was observed in 20 patients (61%), with a median LPFS of 7.0 months in the recurrent group. No significant association was found between LPFS and the extent of tumor removal, postoperative chemotherapy, and RT.</p><p><strong>Conclusions: </strong>This study highlights a relatively prolonged survival period following salvage surgery for local progression of BM after irradiation. Salvage surgery is a treatment option in patients with good extracranial control and performance status. The high recurrence rate following salvage treatment underscores the need for developing additional treatment approaches.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"163"},"PeriodicalIF":1.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223992","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":"Immediate titanium mesh cranioplasty after debridement of post-craniotomy infection.","authors":"Micaela Uberti, Navneet Singh, Andrew J Martin","doi":"10.1007/s00701-025-06509-4","DOIUrl":"10.1007/s00701-025-06509-4","url":null,"abstract":"<p><strong>Purpose: </strong>For post-craniotomy surgical site infection (SSI) involving the bone, typical management involves removal of the bone flap and delayed cranioplasty. The disadvantages of delayed cranioplasty include cosmetic deformity, vulnerability of unprotected brain, skin contraction, syndrome of the trephined and the risks of further surgery. Second procedures also add to cost due to surgical time, hospital stay, and opportunity costs for patients from being away from work.</p><p><strong>Methods: </strong>We retrospectively reviewed patients who underwent post-craniotomy bone flap removal due to SSI, with immediate titanium mesh cranioplasty. The primary outcome was re-operation due to persistent infection or wound healing complications. The secondary outcome was re-operation due to unacceptable cosmetic result.</p><p><strong>Results: </strong>Nineteen patients were included between 2018 to 2024. Two patients required additional debridement and removal of the titanium mesh due to persistent infection. Another patient had the plate replaced with PEEK due to poor skin quality, wound breakdown and an unacceptable cosmetic result. Two further patients with bifrontal craniotomies had the mesh replaced for cosmetic reasons. Fourteen patients had long term resolution with no further procedure.</p><p><strong>Conclusion: </strong>Immediate TM insertion at the time of bone flap removal is an acceptable option in the management of post-craniotomy SSI. It seems the overall complication rate is comparable to delayed titanium cranioplasty, with the benefit of avoiding the risks and costs of a second operation. Cosmetic results are worse with larger defects, but these patients can still benefit from early TM placement by making operative conditions easier when the custom made, delayed cranioplasty is inserted.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"161"},"PeriodicalIF":1.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214621","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":"Adjunctive middle meningeal artery embolization for non-acute subdural hematoma: A GRADE-assessed meta-analysis and trial sequential analysis on randomized trials.","authors":"Mohamed S Elgendy, Mohamed Rifai, Amira M Taha, Mohamed A Faheem, Hosam I Taha, Mostafa Meshref, Mariam Elewidi, Mohamed Abuelazm","doi":"10.1007/s00701-025-06574-9","DOIUrl":"10.1007/s00701-025-06574-9","url":null,"abstract":"<p><strong>Background and purpose: </strong>Non-acute subdural hematoma (NASDH) is a prevalent neurological condition, encompassing chronic and subacute types. Despite standard-care, including surgical evacuation and medical management, recurrence rates remain high. Emerging evidence suggests that middle meningeal artery embolization (MMAE) as an adjunctive procedure may reduce recurrence. This study evaluates the efficacy and safety of MMAE in NASDH.</p><p><strong>Methods: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, EMBASE, WOS, Scopus, and Cochrane until November 2024. The analysis presented risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI) using R software. The GRADE system assessed evidence certainty, alongside trial sequential analysis for result reliability.</p><p><strong>Prospero id: </strong>CRD42024625504.</p><p><strong>Results: </strong>Six RCTs and 1,544 patients were included, with an average of 4.7 months follow-up. Adjunctive MMAE, compared to standard-care, significantly reduced hematoma recurrence (8% vs 15.6%; RR: 0.52; 95% CI: [0.37:0.73]; P < 0.01) and surgical rescue (4.5% vs. 12.7%; RR: 0.36; 95% CI: [0.25:0.53]; P < 0.01). However, no significant effect was found for recurrence without surgery (P = 0.94), hematoma volume (P = 0.18), thickness (P = 0.34), or hospital stay (P = 0.37). Infection rates were higher with MMAE (8.4% vs. 4.8%; RR: 1.81; 95% CI: [1.23:2.66]; P < 0.01), but adverse events (AEs), serious AEs, intracranial hemorrhage, stroke, and mortality showed no significant differences.</p><p><strong>Conclusion: </strong>Adjunctive MMAE reduced hematoma recurrence and surgical rescue rates in NASDH with an acceptable safety profile despite increased infection rates. However, further large-scale trials with extended follow-ups are needed.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"160"},"PeriodicalIF":1.9,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198054","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":"Impact of patient positioning on bleeding rate in stereotactic brain biopsies: semi-sitting versus supine position.","authors":"Lapo Bonosi, Giovanni Carone, Riccardo Pascuzzo, Marta Bonada, Evelyn Gisell Belotti, Annica Piccardi, Francesco DiMeco, Massimiliano Del Bene","doi":"10.1007/s00701-025-06573-w","DOIUrl":"10.1007/s00701-025-06573-w","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic brain biopsies (SBB) are essential procedures to achieve histological diagnoses in brain tumor patients. Hematoma occurrence is a rare event but can lead to significant morbidity and mortality. This study investigates whether patient positioning during the procedure-semi-sitting versus supine-can affect the rate of bleeding.</p><p><strong>Methods: </strong>We retrospectively reviewed 78 procedures of SBB, performed at Fondazione IRCCS Istituto Neurologico \"C. Besta\" in Milan, Italy, during the last year. The patients were allocated into two groups based on their positioning during the operation: semi-sitting (39 patients) and supine (39 patients). Medical records, operative notes, CT scans, and histological findings were reviewed. Group comparisons were performed with the Mann-Whitney test for continuous variables and with a Chi-squared test or Fisher test for categorical variables. The Benjamini-Hochberg procedure was used for multiple testing correction.</p><p><strong>Results: </strong>The incidence of hemorrhagic complications was significantly lower in the semi-sitting group (7.7%) compared to the supine group (33.3%). Statistical analysis highlighted the semi-sitting position as a potential protective factor against bleeding (p = 0.0101).</p><p><strong>Conclusion: </strong>The semi-sitting position during SBB seems to reduce the risk of hemorrhagic complications compared to the supine position. These findings highlight the importance of patient positioning in ensuring the safety and influencing the outcomes of neurosurgical procedures.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":"159"},"PeriodicalIF":1.9,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191265","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}