Acta Neurochirurgica最新文献

{"title":"Tumor resection in paramedian structures of the frontal lobe poses a risk for corpus callosum infarction","authors":"Yoshiteru Shimoda,&nbsp;Masayuki Kanamori,&nbsp;Shinichiro Osawa,&nbsp;Shingo Kayano,&nbsp;Ryuta Saito,&nbsp;Mugikura Shunji,&nbsp;Tominaga Teiji,&nbsp;Hidenori Endo","doi":"10.1007/s00701-025-06555-y","DOIUrl":"10.1007/s00701-025-06555-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Surgeons resecting intraparenchymal tumors should be aware of potential white matter ischemia resulting from damage to the medullary artery arising from the cerebral cortex. In the vicinity of the paramedian structure, crucial brain regions for higher brain function such as corpus callosum and cingulate cortex are located. However, the actual area of ischemia induced by damaging the medullary artery supplying the paramedian structures is not known. The present study investigated the ischemic field following tumor resection in paramedian structures of the frontal lobe.</p><h3>methods</h3><p>Patients having intraparenchymal tumors with lesions in the paramedian structures of the frontal lobe (superior frontal gyrus or cingulate gyrus) resected between April 2016 and June 2022 at Tohoku University Hospital were included in the study. Magnetic resonance images obtained within 72 h after surgery were used to retrospectively examine the extent of the resection and the distribution of ischemic complications. Related postoperative clinical symptoms were assessed using medical records.</p><h3>Results</h3><p>Thirty-three cases matched the inclusion criteria. The median age was 48 years. Cases comprised patients with an astrocytoma IDH-mutant (<i>n</i> = 11), oligodendroglioma IDH-mutant, and 1p/19q-codeletion (<i>n</i> = 12), and glioblastoma IDH-wildtype (<i>n</i> = 10). The main locations were superior frontal gyrus only (<i>n</i> = 17), cingulate gyrus only (<i>n</i> = 8), and both the frontal lobe and cingulate gyrus (<i>n</i> = 8). The cingulate gyrus was removed in 19 cases. In 16 of the 19 cases, ischemic foci were observed in the adjacent corpus callosum. In the 14 cases in which the cingulate gyrus was not removed, no ischemic foci appeared in the corpus callosum. Three cases exhibited a prolonged disturbance of consciousness after the second postoperative day, all with corpus callosum infarction.</p><h3>Conclusion</h3><p>Surgeons resecting intraparenchymal tumors in the paramedian structures of the frontal lobe, especially the cingulate gyrus, should be aware of the potential for ischemia foci emerging in the corpus callosum.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06555-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143938314","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":"Intracranial pressure dynamics, cerebral autoregulation, and brain perfusion after decompressive craniectomy in malignant middle cerebral artery infarction: is there a role for invasive monitoring?","authors":"Modar Alhamdan,&nbsp;Anders Hånell,&nbsp;Timothy Howells,&nbsp;Anders Lewén,&nbsp;Per Enblad,&nbsp;Teodor Svedung Wettervik","doi":"10.1007/s00701-025-06537-0","DOIUrl":"10.1007/s00701-025-06537-0","url":null,"abstract":"<div><h3>Objective</h3><p>Malignant middle cerebral artery infarction (MMI) is a severe neurological condition. Decompressive craniectomy (DC) is an established lifesaving surgical treatment. However, the role of neurocritical care with monitoring and management of the intracranial pressure (ICP), pressure reactivity index (PRx), cerebral perfusion pressure (CPP), and optimal perfusion pressure (CPPopt) remain unclear. This study aims to examine the dynamics of these variables post-DC in relation to clinical outcome.</p><h3>Methods</h3><p>This retrospective study included 70 MMI patients who underwent DC with ICP monitoring of at least 12 hours and available data of clinical outcome (modified Rankin Scale [mRS] at 6 months). The associations between mRS and cerebral physiology (ICP, PRx, CPP, and ∆CPPopt) was analysed and presented in different outcome heatmaps over the first 7 days following DC.</p><h3>Results</h3><p>ICP above 15 mmHg was associated with unfavourable outcome, particularly for longer durations. As PRx exceeded zero, outcome worsened progressively, and values above 0.5 correlated to poor outcome regardless of duration. As CPP dropped below 80 mmHg, there was a transition from favourable to unfavourable outcome. Negative ∆CPPopt, particularly below -20 mmHg, corresponded to unfavourable outcome. In two-variable heatmaps, elevated PRx combined with high ICP, low CPP or negative ∆CPPopt correlated with worse outcome.</p><h3>Conclusion</h3><p>Invasive ICP-monitoring may provide prognostic information for long-term recovery in MMI patients post-DC. The study highlighted disease-specific optimal physiological intervals for ICP, PRx, CPP, and ΔCPPopt. Of particular interest, the autoregulatory variable, PRx, influenced the safe and dangerous ICP, CPP, and ∆CPPopt intervals.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06537-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925522","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 transorbital approach for anterior communicating artery aneurysms: How I do it","authors":"Walter C. Jean,&nbsp;Franco Rubino,&nbsp;Peter Harris,&nbsp;Miguel Sàez-Alegre","doi":"10.1007/s00701-025-06556-x","DOIUrl":"10.1007/s00701-025-06556-x","url":null,"abstract":"<div><h3>Background</h3><p>The transorbital approach through the roof of the orbit can be utilized safely for the clip obliteration of ACOM aneurysms.</p><h3>Method</h3><p>We demonstrate the technique and describe the limited indications for its application. The operation proceeds by strictly following the anatomic dissection of the optic nerve, A1 segment of the ACA and then dissection and clipping of the aneurysm.</p><h3>Conclusion</h3><p>For the properly chosen patient and aneurysm, the transorbital approach has an excellent cosmetic outcome and can safely eliminate the aneurysm with great patient satisfaction.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06556-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143925521","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":"Regional variation in traumatic brain injury patterns, management and mortality: a nationwide Swedish cohort study","authors":"Francisco Leal-Méndez,&nbsp;Anders Lewén,&nbsp;Amanda Gu,&nbsp;Anders Hånell,&nbsp;Lina Holmberg,&nbsp;Per Enblad,&nbsp;Fredrik Linder,&nbsp;Teodor Svedung Wettervik","doi":"10.1007/s00701-025-06557-w","DOIUrl":"10.1007/s00701-025-06557-w","url":null,"abstract":"<div><h3>Background</h3><p>Sweden covers a large land area, but is sparsely populated. The country is divided into six heterogenous healthcare regions, each with different geographic conditions and referral patterns when it comes to traumatic brain injury (TBI). This study aimed to explore the variation in demography, injury patterns, care pathways, management, and mortality (30 d) for TBI patients within the country.</p><h3>Methods</h3><p>A nationwide, observational study, using data from the Swedish Trauma Registry (SweTrau) between 2018–2022, was performed. A total of 5036 TBI patients were included. Data on demography, admission status (through Glasgow Coma Scale [GCS] value at arrival at first managing hospital), injury-related variables, and mortality (30 d) were evaluated.</p><h3>Results</h3><p>The median age was 65 years (interquartile range 46–78), and the majority of patients were male, had sustained fall-related injuries, and were conscious upon admission. Slight, but significant differences (p &lt; 0.05) existed among the regions in these variables. In multivariate logistic regression models, the healthcare region (p &lt; 0.05) was independently associated with patient referral to a university hospital (as compared to care at a local hospital alone), craniotomy rate, and receiving an intracranial pressure-monitoring device, after adjustment for demographic and injury variables. In similar regressions regarding mortality, specific healthcare regions (p &lt; 0.05) were independently associated with said outcome.</p><h3>Conclusions</h3><p>The study highlights, from a systems-level perspective, that there was a significant variation in care pathways and management among the six healthcare regions in Sweden, which might have impacted on clinical outcome. These findings call for more granular studies to understand which aspects of patient management that were particularly beneficial or detrimental for patient survival and recovery.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06557-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919132","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 superb microvascular ultrasound imaging in glioma: novel quantitative analysis correlates with tumour grade","authors":"Luke Dixon,&nbsp;Alistair Weld,&nbsp;Dolin Bhagawati,&nbsp;Neekhil Patel,&nbsp;Stamatia Giannarou,&nbsp;Matthew Grech-Sollars,&nbsp;Adrian Lim,&nbsp;Sophie Camp","doi":"10.1007/s00701-025-06535-2","DOIUrl":"10.1007/s00701-025-06535-2","url":null,"abstract":"<div><h3>Background</h3><p>Accurate grading of gliomas is critical to guide therapy and predict prognosis. The presence of microvascular proliferation is a hallmark feature of high grade gliomas which to directly visualise traditionally requires targeted surgical biopsy of representative tissue. Superb microvascular imaging (SMI) is a novel high resolution Doppler ultrasound technique which can uniquely define the microvascular architecture of whole tumours.</p><h3>Methods</h3><p>We examined both qualitative and quantitative vascular features of 32 gliomas captured with SMI, analysing flow signal density, vessel number, branching points, curvature, vessel angle deviation, fractal dimension, and entropy.</p><h3>Results</h3><p>High-grade gliomas exhibit significantly greater vascular complexity and disorganisation, with increased fractal dimension and entropy, correlating with known histopathological markers of aggressive angiogenesis. The integrated ROC model achieved high accuracy (AUC = 0.95).</p><h3>Conclusions</h3><p>This study leveraged SMI to provide further insights into the microvascular architecture of gliomas which is not resolvable by magnetic resonance imaging. Applying novel quantitative analysis the study demonstrated that there are quantifiable differences in vascular morphology between high grade and low-grade gliomas. This unique <i>in vivo</i> imaging of glioma vascularity and quantification warrants further exploration as a potential new diagnostic and prognostic tool that may support glioma management, intraoperative decision-making and informing future prognosis.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06535-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908636","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 to: A study on the effectiveness of multiple intraoperative disinfections and bacteriological monitoring in reducing postoperative intracranial infection rates in transnasal endoscopic skull base surgery","authors":"Duanzheng Cao,&nbsp;Danke Shen,&nbsp;Zhenyan Shi,&nbsp;Jie Wu,&nbsp;Shenhao Xie,&nbsp;Hai Luo,&nbsp;Bin Tang","doi":"10.1007/s00701-025-06550-3","DOIUrl":"10.1007/s00701-025-06550-3","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06550-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How we do it: Ultrasound-guided scuba technique for evacuation of intracerebral hematoma","authors":"Alejandra Mosteiro,&nbsp;Alberto Di Somma,&nbsp;Luis Reyes,&nbsp;Ana Rodríguez-Hernández,&nbsp;Ramon Torné","doi":"10.1007/s00701-025-06539-y","DOIUrl":"10.1007/s00701-025-06539-y","url":null,"abstract":"<div><h3>Background</h3><p>Minimally invasive treatment of intracerebral hematomas is gaining importance following recent trials. Clot evacuation must minimise collateral damage while assuring optimal blood-volume reduction. Technical refinements call for systematic yet dynamic procedures, where ultrasound is an asset.</p><h3>Method</h3><p>Description of the “Scuba” procedure and workflow: stereotactic canula insertion, clot evacuation with aspiration-debriding system under endoscopic view. Step-by-step ultrasound findings detailed.</p><h3>Conclusion</h3><p>ICH endoscopic evacuation may become a workhorse for cerebrovascular surgeons. Ultrasound provides real-time feedback on hematoma evacuation, becoming a reliable dynamic element in intraoperative decision-making. Yet, US requires a different operative setup and adds on to the learning curve.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06539-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896676","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":"MR-guided Laser Interstitial Thermal Therapy mesencephalotomy for medically intractable malignant pain","authors":"Mickael Aubignat,&nbsp;Jean-Marc Constans,&nbsp;Martial Ouendo,&nbsp;Jean-Philippe Arnault,&nbsp;Claire Josse,&nbsp;Christine Desenclos,&nbsp;Michel Lefranc","doi":"10.1007/s00701-025-06544-1","DOIUrl":"10.1007/s00701-025-06544-1","url":null,"abstract":"<div><p>Stereotactic mesencephalotomy is a neurosurgical technique designed to sever spinothalamic pain transmission pathways for medically intractable pain. This report presents the first case of Magnetic Resonance-guided Laser Interstitial Thermal Therapy (MRgLITT) mesencephalotomy for severe malignant pain due to metastatic melanoma. The procedure significantly reduced the patient’s pain, with a postoperative visual analog scale (VAS) score decreasing from &gt; 7 to &lt; 3. No adverse effects were observed. The case underscores the potential of MRgLITT mesencephalotomy as a precise, minimally invasive option for pain management in palliative care settings.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06544-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896672","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 regarding “Is Knosp enough? A novel classification for Acromegaly: a retrospective analysis of cure rates and outcome predictors in a large tertiary centre”","authors":"Victor E. Staartjes,&nbsp;Luca Regli,&nbsp;Carlo Serra","doi":"10.1007/s00701-025-06511-w","DOIUrl":"10.1007/s00701-025-06511-w","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06511-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892705","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":"Analysis of primary referral patterns and return to work in patients with incident back pain due to lumbar disc herniation","authors":"Mikkel Kjeldgaard,&nbsp;Berit Schiøttz-Christensen,&nbsp;Janus Nikolaj Laust Thomsen,&nbsp;Christian Volmar Skovsgaard,&nbsp;Carsten Reidies Bjarkam","doi":"10.1007/s00701-025-06546-z","DOIUrl":"10.1007/s00701-025-06546-z","url":null,"abstract":"<div><h3>Objective</h3><p>To examine primary referral patterns and return to work in patients with incident back pain due to Lumbar Disc Herniation (LDH).</p><h3>Methods</h3><p>Nationwide register-based cohort study including all Danish residents aged 18–65 who were referred from primary to specialized healthcare in 2017 with incident back pain and subsequently received a diagnosis of lumbar disc herniation (LDH), defined by ICD-10 codes DM51X.X. Patients were identified using the Danish National Patient Registry (DNPR), including both those directly diagnosed with LDH and those who initially received a diagnosis of nonspecific low back pain (ICD-10: DM54) that progressed to LDH within one year. Demographic data were obtained from the Danish Civil Registration System (CRS), and work capacity outcomes were assessed over a two-year follow-up using the Danish Register for Evaluation of Marginalization (DREAM).</p><h3>Results</h3><p>A total of 30,082 persons, corresponding to 0.8% of the Danish population aged 18–65, were referred from primary health care to specialized health care with incident back pain and a final diagnosis of LDH. Of these, 5356 (17.8%) were referred to an emergency department, 14,628 (48.6%) to a medical department, and 10,098 (33.6%) to a surgical department. However, the admission rate and the initial department referred to varied widely between regions. Overall, 1915 (6.4%) underwent surgery. Surgical departments operated more frequently on patients with previous high (11%) or intermediate (14%) work capacity than on those with low work capacity (4%), although the latter were more often referred for surgical evaluation. Over 80% of patients with high or intermediate work capacity maintained or returned to work within a year.</p><h3>Conclusion</h3><p>In Denmark, referral from primary to specialized health care of patients with incident back pain due to LDH varies considerable between regions highlighting the need for more standardized referral pathways. Specifically, ensuring a better balance between emergency, medical, and surgical referrals could reduce unnecessary emergency admissions and improve the precision of surgical referrals optimizing the use of surgical capacity and healthcare resources in general.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06546-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892741","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}