Acta Neurochirurgica最新文献

{"title":"Idiopathic intracranial hypertension and pregnancy: outcomes in previously shunted women","authors":"Manolis Polemikos,&nbsp;Hans E. Heissler,&nbsp;Elvis J. Hermann,&nbsp;Dirk Scheinichen,&nbsp;Constantin S. von Kaisenberg,&nbsp;Peter Hillemanns,&nbsp;Joachim K. Krauss","doi":"10.1007/s00701-026-07017-9","DOIUrl":"10.1007/s00701-026-07017-9","url":null,"abstract":"<div><h3>Objective</h3><p>Idiopathic intracranial hypertension (IIH) typically affects obese women of reproductive age. Ventriculoperitoneal (VP) shunting is an established surgical treatment for severe or medically refractory cases. There is limited knowledge regarding the management of these patients when they become pregnant. Here, we report our multidisciplinary experience in this subgroup of IIH.</p><h3>Methods</h3><p>Our database on IIH was retrospectively screened for women who were diagnosed and treated with a VP shunt from 2005 to 2025. We analyzed onset of IIH in relation to pregnancy, number of pregnancies resulting in live births before and after VP shunting, and the mode of delivery.</p><h3>Results</h3><p>Overall 61 women with IIH underwent VP shunting during the study period. Nine women had 12 pregnancies resulting in live births at a median of 40.5 months after VP shunting (range 6–108). Onset of IIH was not related to the occurrence of pregnancies in all but one patient. 9/12 pregnancies resulted in vaginal delivery. Adjustment of the shunt valve was not required in these patients. One patient experienced progressive visual loss refractory to acetazolamide treatment during the first trimester. VP shunting at 11 weeks of gestation facilitated stabilization of her visual symptoms and delivery via elective Caesarean section. There were no peripartum cases of infection or malfunction of the shunt system.</p><h3>Conclusions</h3><p>The complexity of IIH during pregnancy requires a multidisciplinary approach in order to achieve an optimal outcome. In our cohort of previously shunted IIH patients with programmable valves and gravitational units, neither the occurrence of a pregnancy nor a vaginal delivery increased the risk for disease recurrence or deterioration. In severe cases, VP shunting remains a treatment option during pregnancy when clinically indicated.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13529839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863065","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":"Correction: Efficacy of intraoperative indocyanine green videoangiography (ICG-VA) and flow 800 in the surgical management of intracranial aneurysms: a systematic review and meta-analysis","authors":"Albert Gabriel Turpo-Peqqueña,&nbsp;Santiago Alejandro Santos‑Vargas,&nbsp;Harlly Romed Loza‑Chipa,&nbsp;Francisco Martins Lamas,&nbsp;George Alejandro Espinoza‑Laura,&nbsp;Claudia Solange Núñez‑Basurco,&nbsp;Diego Napoleon Medina‑Neira,&nbsp;Valeria Alejandra Benites‑Bustamante,&nbsp;Rayza Ruth Osorio‑Pacheco,&nbsp;Josue Rodrigo Turpo‑Peqqueña,&nbsp;Gladys Huanca‑Quispe,&nbsp;Cristhian Adolfo Vizcarra‑Vizcarra,&nbsp;Badhin Gómez,&nbsp;Julian Alejandro Rivillas,&nbsp;Richard Hernández‑Mayori","doi":"10.1007/s00701-026-06990-5","DOIUrl":"10.1007/s00701-026-06990-5","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06990-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148783070","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":"External validation of a machine learning-based web application for personalized testing of objective functioning using the five-repetition sit-to-stand test","authors":"Kenneth Arockia,&nbsp;Massimo Bottini,&nbsp;Anita M. Klukowska,&nbsp;Victor Gabriel El-Hajj,&nbsp;Maria Gharios,&nbsp;Ali Buwaider,&nbsp;Carlo Serra,&nbsp;Luca Regli,&nbsp;Marc L. Schröder,&nbsp;Victor E. Staartjes","doi":"10.1007/s00701-026-07005-z","DOIUrl":"10.1007/s00701-026-07005-z","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Purpose&lt;/h3&gt;&lt;p&gt;Simple generalized thresholds for assessing functional impairment in clinical testing are limited, as they fail to consider patient-specific properties such as age, body height, and body mass index. A previously developed machine learning-based model for personalized testing using the five-repetition sit-to-stand (5R-STS) test, that estimates personalized upper limits of normal (ULN) to identify objective functional impairment (OFI) was externally validated to evaluate its performance and generalizability across cohorts.&lt;/p&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;p&gt;Only healthy individuals were included in the study. After the machine learning-based model was applied to this external dataset, expected and observed 5R-STS test times were compared using standardized performance assessment metrics including root mean square error (RMSE), mean absolute error (MAE), and R&lt;sup&gt;2&lt;/sup&gt; values. Additionally, a Bland–Altman analysis was performed to assess agreement between observed and expected values. Validation of the expected ULN involved comparing the proportion of individuals exceeding their personalized thresholds with the corresponding proportion based on the generalized threshold. Subgroup analyses by test setting and country of residence were additionally performed, along with a graphical assessment of model performance.&lt;/p&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;Application of the model to 171 healthy individuals resulted in an RMSE of 2.33 (95% CI: 1.93 to 2.73) seconds, MAE of 1.70 (95% CI: 1.47 to 1.94) seconds, and R&lt;sup&gt;2&lt;/sup&gt; of 0.064 (95% CI: -0.25 to 0.15). The Bland–Altman analysis demonstrated a mean bias of -1.1 s. Based on the personalized ULNs, OFI was classified in 17.5% of individuals, compared to 6.4% when using the generalized threshold of 10.4 s. These analyses indicated limited external generalization, with acceptable approximation for some faster and mid-range test times but systematic underestimation of slower test times. Multivariable regression analyses showed that remote testing was independently associated with greater prediction bias and higher odds of personalized ULN exceedance compared with supervised testing (adjusted mean difference: − 0.90 s; adjusted OR: 10.7). Exploratory country-of-residence analyses showed differences across the three largest national subgroups. 130 (76.1%) rated ease of use as excellent, and 145 (84.9%) rated clarity of instructions as excellent. 143 participants (83.6%) indicated that they prefer the 5R-STS over a battery of questionnaires.&lt;/p&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;p&gt;In the context of personalized testing, moving toward individually focused precision assessment of patients requires rigorous external validation to ensure the robustness of such applied computational methods. In this external validation, the model demonstrated limited generalization including a systematic underestimation of slower test times and insufficient personalized ULN calibration. These findings indicate that external validity of models de","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-07005-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148782859","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":"Response To: Chiari Malformation Type 0: Methodological Concerns Regarding the Null Structural Finding","authors":"B. Candan,&nbsp;B. Ozkal,&nbsp;E. Top","doi":"10.1007/s00701-026-07008-w","DOIUrl":"10.1007/s00701-026-07008-w","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-07008-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148752334","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 to the Editor: C2 schwannoma resection","authors":"Atul Goel","doi":"10.1007/s00701-026-06994-1","DOIUrl":"10.1007/s00701-026-06994-1","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06994-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597673","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":"Reply to: Letter “The invisible “cuneus vein”…does it even exist?” on “The cuneus vein: initial anatomical description and preservation technique for posterior interhemispheric approaches”","authors":"Muhammet Enes Gurses,&nbsp;Abuzer Gungor,&nbsp;Uğur Türe","doi":"10.1007/s00701-026-06989-y","DOIUrl":"10.1007/s00701-026-06989-y","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13395982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560382","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":"Endoscopic techniques for removal of intraorbital foreign bodies - a clinical series.","authors":"Robert Chrzanowski, Magdalena Rybaczek, Zenon Mariak, Andrzej Sieskiewicz, Tomasz Lyson","doi":"10.1007/s00701-026-06986-1","DOIUrl":"10.1007/s00701-026-06986-1","url":null,"abstract":"<p><strong>Background: </strong>Management of intraorbital foreign bodies (IOFBs) is challenging due to the confined space and proximity of neurovascular and ocular structures. The increasing adoption of endoscopic techniques has expanded minimally invasive treatment options. We report operative corridors, indications, and outcomes of various endoscopic approaches in a consecutive series.</p><p><strong>Method: </strong>We analyzed 16 patients with IOFBs treated between 2015 and 2023 at a tertiary university center. All procedures were performed using exclusively endoscopic techniques. Eleven IOFBs were metallic and five organic. Surgical strategy was individualized according to IOFB location and included endoscopic transethmoidal, transmaxillary, transconjunctival, and retrocantal approaches. Neuronavigation was used in all cases with adjunctive fluoroscopy or ultrasonography when indicated.</p><p><strong>Results: </strong>Nine IOFBs were intraconal and seven extraconal. Successful removal was achieved in 13 of 16 patients. All unsuccessful attempts involved small, non-ferromagnetic air-gun pellets located deep in the posterior orbit; these patients remain under observation without delayed inflammatory complications. No new postoperative visual deterioration or neurological deficits occurred. Transient periorbital edema was observed in all patients and resolved spontaneously. Cosmetic outcomes were satisfactory in all but one case with extensive initial soft-tissue loss. In three patients with presumed orbital tumors, removal of wooden fragments led to regression of inflammatory masses on follow-up.</p><p><strong>Conclusions: </strong>Endoscopic techniques represent a valuable alternative to traditional open approaches, especially for deep-seated lesions. The optimal approach should prioritize the most direct path to the target, avoiding critical structures such as the optic nerve, extraocular muscles, ciliary nerves and vessels to minimize the risk of permanent deficits.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219735","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":"Moving on in hydrocephalus imaging: from 2D to 3D biomarkers","authors":"Raffaele Da Mutten,&nbsp;Rafael Turczynski Holmgren,&nbsp;Erik Edström,&nbsp;Adrian Elmi-Terander,&nbsp;Victor Egon Staartjes","doi":"10.1007/s00701-026-06985-2","DOIUrl":"10.1007/s00701-026-06985-2","url":null,"abstract":"<div><h3>Purpose</h3><p>Linear two-dimensional indices such as the Evans index, callosal angle, and fronto-occipital horn ratio remain the clinical standard for hydrocephalus assessment, yet are limited by measurement variability, insensitivity to spatial CSF redistribution, and reduced sensitivity to volumetric change over time. This narrative review aims to summarize established two-dimensional indices, their structural limitations, and describe how automated segmentation and radiomic feature extraction enable three-dimensional assessment across four clinical domains.</p><h3>Methods</h3><p>A narrative literature review was conducted using PubMed. Studies addressing hydrocephalus imaging biomarkers, ventricular volumetry, automated segmentation, radiomics, and machine learning applications were reviewed. Reference lists of relevant articles were hand-searched for additional sources. The literature was synthesized across four clinical domains: pediatric hydrocephalus monitoring, differential diagnosis of ventriculomegaly, preoperative prediction of response to cerebrospinal fluid diversion, and longitudinal post-treatment follow-up.</p><h3>Results</h3><p>Across pediatric hydrocephalus monitoring, differential diagnosis of ventriculomegaly, preoperative prediction of response to CSF diversion, and post-shunt longitudinal follow-up, three-dimensional volumetric and radiomic approaches consistently outperform linear indices. Machine learning models report AUCs exceeding 0.9 for differential diagnosis and shunt response prediction. Automated segmentation has reached excellent performance for detection tasks, and volumetry is more sensitive to postoperative change than the Evans index.</p><h3>Conclusions</h3><p>Despite strong metric performance, clinical translation remains limited by small single-centre datasets, missing external validation, and undefined thresholds for clinically meaningful volumetric change. Embedding validated tools into radiological workflows and clinical guidelines will be essential before three-dimensional biomarkers can improve routine hydrocephalus care.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13400597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148534827","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":"Reply to: Letter “what defines an anatomic structure?” on “The Cuneus Vein: Initial Anatomical Description and Preservation Technique for Posterior Interhemispheric Approaches”","authors":"Muhammet Enes Gurses,&nbsp;Abuzer Gungor,&nbsp; Uğur Türe","doi":"10.1007/s00701-026-06988-z","DOIUrl":"10.1007/s00701-026-06988-z","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13388653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535002","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":"Delayed remote venous epidural hematoma: direct radiographic identification of a superficial cortical venous source and a review of the literature","authors":"Ege Anil Ucar,&nbsp;Oguz Baran,&nbsp;Goktug Akyoldas,&nbsp;Nazenin Durmus,&nbsp;Yunus Emre Senturk,&nbsp;İhsan Solaroglu","doi":"10.1007/s00701-026-06972-7","DOIUrl":"10.1007/s00701-026-06972-7","url":null,"abstract":"<div><h3>Purpose</h3><p>Delayed remote epidural hematoma (EDH) is an exceptionally rare complication of non-traumatic neurosurgical procedures. Although venous bleeding related to abrupt intracranial pressure or volume redistribution has been proposed, the bleeding source is usually inferred rather than directly visualized. We report a delayed contralateral remote EDH after supratentorial tumor resection with direct radiographic evidence of a superficial cortical venous source and provide a review of the literature.</p><h3>Methods</h3><p>A comprehensive literature search was performed across PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library without temporal restriction. Studies were eligible if they reported individual patient-level data on delayed postoperative epidural hematoma located remote from the operative field after a non-traumatic neurosurgical procedure. Reports of traumatic, intraoperative, immediate, operative-site, or contiguous epidural hematomas were excluded. Two reviewers (E.A.U., O.B.) independently screened records, assessed eligibility, and extracted demographic, clinical, radiological, management, and outcome data for descriptive synthesis. The illustrative case was analyzed with emphasis on clinical and radiographic findings, venous anatomy, and hematoma evolution.</p><h3>Results</h3><p>The structured review identified 14 previously reported patients with delayed remote postoperative EDH; with the present case, 15 patient-level observations were analyzed. Hydrocephalus was documented in 11 patients (73.3%), and CSF diversion or outflow alteration in 8 (53.3%). Altered mental status was the most common presentation at EDH recognition, occurring in 8 patients (53.3%). Surgical evacuation was performed in 14 patients (93.3%) and the present case was the only patient managed entirely without operative evacuation. Overall, 12 patients (80.0%) had favorable outcomes, 3 (20.0%) had residual neurological deficit or functional decline, and no deaths were reported.</p><h3>Conclusions</h3><p>Delayed remote EDH after large-volume supratentorial tumor resection may arise from a superficial cortical venous source. Postoperative sequential imaging in high-risk resections, with preoperative hydrocephalus, superficial venous anomaly, or CSF diversion, may identify remote EDH before neurological deterioration. In selected neurologically intact patients with stable or decreasing hematoma volume, conservative management under close neurosurgical surveillance may be a reasonable approach.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"168 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-026-06972-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497012","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}