Acta Neurochirurgica最新文献

{"title":"Improving methodology of radiosurgery for posterior fossa cavernomas: higher volume, lower dose","authors":"François Nataf,&nbsp;Nathaniel Scher,&nbsp;Marc Bollet,&nbsp;Guillaume Mulier,&nbsp;Andrei Birladeanu,&nbsp;Lucian Sopanda,&nbsp;Jérôme Lambert,&nbsp;Gauthier Bouilhol,&nbsp;Stéphanie Guey,&nbsp;Homa Adle-Biassette,&nbsp;Anne-Laure Bernat,&nbsp;Rosaria Abbritti,&nbsp;Thibault Passeri,&nbsp;Emmanuel Mandonnet,&nbsp;Sébastien Froelich","doi":"10.1007/s00701-024-06409-z","DOIUrl":"10.1007/s00701-024-06409-z","url":null,"abstract":"<p>Cavernous malformations (CM) of the brain are vascular abnormalities that carry a risk of bleeding, posing significant neurological and life-threatening challenges, particularly in posterior fossa. The efficacy of radiosurgery for cavernomas still remains a matter of debate, largely due to technical and statistical limitations. In this study, we present a series of posterior fossa cavernomas treated using CyberKnife radiosurgery, employing an innovative approach that integrates both technical and statistical advancements.</p><p>We conducted a prospective series involving 35 posterior fossa cavernomas in 33 patients treated with low-dose radiosurgery protocols (12 Gy in a single fraction or 18 Gy in 3 fractions). Compared to previously published series, our approach targeted a larger treatment volume, encompassing the entire hemosiderin ring surrounding the cavernoma. Radiosurgery was indicated for cases of hemorrhage or progressive neurological deficits in anatomically challenging, nonsurgical areas. The statistical analysis was designed to address the unknown onset time of cavernoma prior to radiosurgery, enabling a more accurate calculation of the hemorrhage incidence rate before treatment. Follow-up evaluations, including clinical assessments and MRI, were conducted at 3-6-9-12-18-24 months and subsequently on an annual basis.</p><p>With a mean follow-up duration of 26 months, exceeding the previously described latency period, and a median [IQR] follow-up of 13 months [8.7-30.4] which represents approximately half the latency period, only one patient experienced a recurrence of hemorrhage, occurring 20 months post-treatment and remaining asymptomatic. No patients exhibited radio-induced parenchymal changes or clinical deterioration following radiosurgery.</p><p>These preliminary results support the strategy of increasing the target volume while reducing the radiation dose for cavernous malformations. We further recommend incorporating sensitivity analyses to evaluate the robustness of results, particularly in the context of uncertainties surrounding the time of onset of cavernomas.</p>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06409-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073392","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":"Perioperative complications in spinal trauma patients: does timing matter?","authors":"Charlotte Y. Adegeest,&nbsp;Cas J. Hilke,&nbsp;Godard C. W. de Ruiter,&nbsp;Mark P. Arts,&nbsp;Carmen L. Vleggeert-Lankamp,&nbsp;Raoul D. Martin,&nbsp;Wilco C. Peul,&nbsp;Paula Valerie ter Wengel","doi":"10.1007/s00701-025-06442-6","DOIUrl":"10.1007/s00701-025-06442-6","url":null,"abstract":"<div><h3>Background</h3><p>Early surgery in traumatic spinal fracture treatment may facilitate prompt mobilization, encountering affiliated complications. However, the safety and the benefits of early surgery are being questioned in spinal trauma patients. Therefore, the objective of this retrospective study is to investigate the effect of surgical timing on perioperative complications in these patients.</p><h3>Methods</h3><p>Spinal trauma patients who underwent surgery between 2010 and 2020 in two Dutch Level-I trauma centers were included retrospectively and divided into an early (&lt; 24 h), late (between 24 and 72 h) and delayed (&gt; 72 h) surgical cohort. The primary outcome was the occurrence of peri-operative complications. Besides surgical timing, trauma and patient-specific factors were also analyzed as potential risk factors for the occurrence of complications.</p><h3>Results</h3><p>A total of 394 patients were included, of whom 149 received early, 159 late and 86 delayed surgical treatment. The occurrence of perioperative complications was significantly associated with age, body mass index, comorbidities, ASA grade 3 and 4, spinal cord injury (SCI), AO Spine type C injury, additional chest injury, and surgical delay. A multivariable analysis showed that age, ASA category, AO Spine classification and SCI were significantly associated with perioperative complications. Moreover, a subsequent analysis in non-SCI patients demonstrated an association between perioperative complications and delayed surgery.</p><h3>Conclusions</h3><p>In this study, delayed surgical treatment is potentially associated with more perioperative complications compared to early surgery in non-SCI patients. Other possible risk factors for the occurrence of perioperative complications may be older age, ASA 3 and 4, AO spine C injury and SCI.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143073323","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":"Comparison of surgical approaches and outcome for symptomatic pineal cysts: microscopic/endoscopic fenestration vs. stereotactic catheter implantation","authors":"Michael Schmutzer-Sondergeld,&nbsp;Aylin Gencer,&nbsp;Tristan Schmidlechner,&nbsp;Hanna Zimmermann,&nbsp;Sebastian Niedermeyer,&nbsp;Sophie Katzendobler,&nbsp;Veit M. Stoecklein,&nbsp;Thomas Liebig,&nbsp;Christian Schichor,&nbsp;Niklas Thon","doi":"10.1007/s00701-025-06445-3","DOIUrl":"10.1007/s00701-025-06445-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Treatment strategies for space-occupying/symptomatic pineal cysts (PC) are still up for debate. In this study we present PC management, outcome data and risk factors for recurrence after surgery, focusing on microscopic/endoscopic procedures vs. stereotactic catheter implantation as alternative treatment concept to permanently drain PC into ventricles/cisterns.</p><h3>Methods</h3><p>This monocentric retrospective analysis included clinical data from all consecutive PC patients treated surgically between 2000 and 2022. Postoperative neurological and functional outcomes, along with perioperative complications, as well as time to PC recurrence and MR-morphological data were evaluated.</p><h3>Results</h3><p>39 patients (median age 32.6 years, range: 5.1–71.6 years) were analyzed. Main presenting symptoms were headaches, visual impairment, and epileptic seizures. In 18 patients (46.2%) an enlarged ventricular system was preoperatively found with 7 patients (18.0%) suffering from occlusive hydrocephalus. 14 patients underwent microscopic/endosocopic surgery, in 25 cases stereotaxy was preferred. No complication was seen in the microsurgery/endoscopy group compared to one intracystic postoperative bleeding (2.6%) and two CSF leaks (5.1%) after stereotaxy (<i>p</i> = 0.5). Overall, clinical improvement and significant cyst volume reduction (<i>p</i> &lt; 0.0001) was seen in all patients. Recurrent PC were seen in 23.1%, independent of surgical procedure (<i>p</i> = 0.2). In cases of recurrence, TTR was 25.2 ± 31.2 months. Male gender (<i>p</i> = 0.01), longer surgery time (<i>p</i> = 0.03) and preoperatively increased Evans index (EI) (<i>p</i> = 0.007) were significant risk factors for PC recurrence in multivariate analysis.</p><h3>Conclusion</h3><p>In patients suffering from PC, microsurgical and stereotactic approaches can improve clinical symptoms at low procedural risk, with equal extent of volume reduction. However, preoperative ventricular enlargement and EI values should be considered for optimal treatment planning to reduce recurrence.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11785698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063224","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":"Anterior communicating aneurysm clipping: How I do it","authors":"Bruno Vernile,&nbsp;Paolo Palmisciano,&nbsp;Sudhakar Vadivelu,&nbsp;Mario Zuccarello","doi":"10.1007/s00701-025-06440-8","DOIUrl":"10.1007/s00701-025-06440-8","url":null,"abstract":"<div><p>Up to 40% of intracranial aneurysms arise from the anterior cerebral artery and anterior communicating artery (ACA-ACoA) complex. The vast variability of vessel anomalies and the surrounding critical structures correlate with severe morbidity and mortality rates in case of rupture. In the era of cutting-edge advantages of endovascular procedures, surgical expertise is reducing. This article describes our institutional surgical technique in managing ACoA aneurysms, focusing on anatomical variants, approach selection, and technical intraoperative nuances.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143045453","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 application of the technique for dorsal median sulcus mapping in intramedullary space occupying surgery: a single-center experience","authors":"Weichao Jiang,&nbsp;Xiaocui Yang,&nbsp;Lihui Lin,&nbsp;Siqi Wu,&nbsp;Yahui Hu,&nbsp;Zirui Su,&nbsp;Deyong Xiao,&nbsp;Jianfeng Guo,&nbsp;Zhan-xiang Wang","doi":"10.1007/s00701-025-06433-7","DOIUrl":"10.1007/s00701-025-06433-7","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the technique for dorsal median sulcus (DMS) mapping and assess its application value in preserving dorsal columnn (DC) function during intramedullary space occupying surgery based on a single-center experience.</p><h3>Methods</h3><p>A retrospective analysis was conducted on 41 cases of intramedullary spinal cord tumor admitted to the Department of Neurosurgery at the First Affiliated Hospital of Xiamen University from March 2017 to August 2023. All included cases underwent intraoperative electrophysiological monitoring, and were divided into a study group (<i>n</i> = 18) and a control group (<i>n</i> = 23), based on whether DMS mapping technique was utilized. The general and clinical data, intraoperative electrophysiological monitoring data, and changes in patients’ deep sensory function before and after surgery were collected. The postoperative neurological function protection of the two groups of patients with intramedullary spinal cord tumor was compared.</p><h3>Results</h3><p>The present study introduces a technique for DMS mapping through the dorsal region stimulation. The amplitude and waveform of somatosensory evoked potentials (SEPs) recorded by the nerve stimulation probe consistently exhibited patterns relative to the dorsal column. This method demonstrated stable localization of the DMS during surgical procedures in all cases (18/18). Furthermore, compared to the double fork bipolar neurostimulator, the concentric bipolar neurostimulator induced SEPs with higher amplitudes in the dorsal column. There was no significant difference in tumor resection duration between the two groups, while postoperative hospitalization duration was shorter in the study group than in control group. During incision of dorsal column, SEP deterioration rate was 0/18 in study group and 4/23 in control group. During the procedure of tumor resection, the rate of deterioration in SEP was 5/18 in the study group and 9/23 in the control group. One week and three months post-surgery, the rate of decline in deep sensation in lower limbs was 4/18 and 3/18 respectively for the study group, while it was 8/23 and 9/23 for the control group.</p><h3>Conclusion</h3><p>The technique of DMS mapping is both stable and feasible, can assist the surgeon in accurately identifying the position of the posterior median sulci of the spinal cord and performing a precise dorsal columnotomy along the electrophysiological midline. This method holds great potential in enhancing the preservation of deep sensory function in patients’ lower limbs post-surgery, thereby enabling them to benefit from the technique. Additionally, SEP Mapping of dorsal column aids in comprehending their function and facilitating rapid localization. Consequently, this approach introduces a novel neuroprotective measure for multimodal electrophysiological monitoring during intramedullary space occupying surgery.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051362","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":"Non-invasive fundoscopy as a tool to estimate intracranial pressure: a large animal model","authors":"Niclas Lynge Eriksen,&nbsp;Frantz Rom Poulsen,&nbsp;Mikkel Schou Andersen,&nbsp;Mathias Just Nortvig","doi":"10.1007/s00701-025-06437-3","DOIUrl":"10.1007/s00701-025-06437-3","url":null,"abstract":"<div><h3>Purpose</h3><p>Intracranial pressure (ICP) monitoring is in most studies considered essential in avoiding secondary brain injury in patients with intracranial pathologies. Invasive monitoring of ICP is accurate but is unavailable in many clinical and prehospital settings. Non-invasive modalities have historically been difficult to implement clinically. The retinal arteriovenous ratio (A/V ratio) has shown promise through its relationship with ICP.</p><p>This study aimed to further elucidate the relationship between ICP, A/V ratio and the intraocular pressure (IOP) measured with non-invasive fundoscopy in a porcine model.</p><h3>Methods</h3><p>We achieved controlled values of ICP ranging from normal (5–15 mmHg) to elevated (&gt; 20 mmHg) within the same animal subject. Six pigs were included. ICP and IOP was measured using an intraparenchymal pressure monitor and a tonometer, respectively. Fundoscopy was performed at baseline and at predefined ICP values.</p><h3>Results</h3><p>Mixed-effects linear regression revealed a significant inverse correlation between A/V ratio and ICP ≥ 20 mmHg (slope coefficient − 0.0026734 [95%-CI: −0.0039347 – (−0.0014121)], <i>p</i> &lt; 0.001). For ICP &lt; 20 mmHg there was no change in A/V ratio (<i>p</i> = 0.987). Similar results were seen for ICP &gt; IOP with a mean IOP of 10 mmHg. A Wald test showed no significant difference between ICP &gt; IOP and ICP ≥ 20 mmHg. ROC curve analysis revealed an AUC of 0.64 for ICP ≥ 20 mmHg and 0.71 for ICP &gt; IOP.</p><h3>Conclusion</h3><p>The results support the hypothesis that an increase in ICP was associated with a decrease in A/V ratio. Although a slightly better fit, the model of ICP &gt; IOP was deemed less clinically relevant than ICP ≥ 20 mmHg because of the subjects’ IOP.</p><p>Further research integrating multifactorial models and machine learning is needed to enhance the diagnostic accuracy of A/V ratio via fundoscopy, enabling it to serve as a cost-effective screening tool.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143035842","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 new 3D full-body scanner analyzing the sagittal and coronal balance of the adult spine: a preliminary prospective observational study","authors":"Tae Hoon Kang,&nbsp;Seokin Jang,&nbsp;Inwook Seo,&nbsp;Minseok Choi,&nbsp;Yongsoo Park,&nbsp;Yohan Lee,&nbsp;Jae Hyup Lee,&nbsp;Minjoon Cho","doi":"10.1007/s00701-024-06411-5","DOIUrl":"10.1007/s00701-024-06411-5","url":null,"abstract":"<div><h3>Background</h3><p>The degenerative spondylosis can cause the difficulty in maintaining sagittal and coronal alignment of spine, and X-ray parameters are the gold standard to analyze the malalignment. This study aimed to develop a new 3D full body scanner to analyze the spinal balance and compare it to X-ray parameters.</p><h3>Methods</h3><p>Ninety-seven adult participants who suffer degenerative spondylosis underwent 3D full body scanning, whole spine X-rays, clinical questionnaires and body composition analyses. The 5 inflection points (ear, shoulder, hip, knee, ankle) of the 3D scanner in the sagittal plane were automatically labeled by an AI algorithm. Three concepts are created including “the angle between two points with respect to the plumb line”, “the horizontal distances between two points in the sagittal plane” and “the angle between three points”. For the coronal plane, the shoulder gradient was analyzed. X-ray parameters of cervical, thoracolumbar and whole spine sagittal balance and coronal balances were compared. The body composition data and clinical questionnaire scores were compared to x-ray and 3D scanner parameters.</p><h3>Results</h3><p>The correlation coefficient (C.C.) of dAB_hor (horizontal distance between ear and shoulder in the sagittal plane) and C2-C7 SVA was 0.478 (<i>p</i>-value &lt; 0.001). The C.C. of aAC_sag (sagittal angle of ear-hip from the plumb line) and ODHA was 0.336 (<i>p</i> &lt; 0.001). About coronal balance, the C.C. of shoulder gradient and clavicle angle from x-ray was 0.373 (<i>p</i> &lt; 0.001). The C.C.s were merely affected by body composition data. But in multiple regression analysis, BMI affected 3D scanner data. Clinical symptoms showed correlations with aBCD(shoulder-hip-knee) and aCDE(hip-knee-ankle angle), which may reflect a compensatory pelvic retroversion and knee flexion for positive sagittal imbalance.</p><h3>Conclusions</h3><p>This new 3D scanner has some strengths like radiation-free methods, correlation with x-ray parameters and clinical symptoms, independence to body composition data, and possibility of analyzing dynamic spine balance.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031751","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":"Radiological and anatomical evaluation of the internal venous system in the context of access to the third ventricle - proposal of a new classification","authors":"Karol Zaczkowski,&nbsp;Piotr Łabętowicz,&nbsp;Małgorzata Podstawka,&nbsp;Rafał Wójcik,&nbsp;Ernest Jan Bobeff,&nbsp;Nicole Zielińska,&nbsp;Bartosz Szmyd,&nbsp;Manuel de Jesus Encarnacion Ramirez,&nbsp;Issael Ramirez,&nbsp;Łukasz Olewnik,&nbsp;Dariusz Jan Jaskólski,&nbsp;Karol Wiśniewski","doi":"10.1007/s00701-025-06431-9","DOIUrl":"10.1007/s00701-025-06431-9","url":null,"abstract":"<div><h3>Background</h3><p>The internal venous system of the brain is a crucial anatomical landmark during accesses to the third ventricle through the foramen of Monro. Many classifications based on radiological assessment of the system have been developed, but they tend to be descriptive and do not highlight favorable anatomical variants. The aim of our study was to create a system based on morphometric measurements to facilitate preoperative decision-making regarding access to third ventricle tumors.</p><h3>Methods</h3><p>We conducted an analysis of 119 MRI scans with SWI sequence using BrainLab software to create a model of the ventricular system, which allowed us to perform radiological measurements. We then validated these findings anatomically using 32 human brain specimens. The analyzed structures included the foramen of Monro (FM), the anterior septal vein (ASV), the thalamostriate vein (TSV), the venous angle (VA), the internal cerebral vein (ICV), and the distance between the FM and VA.</p><h3>Results</h3><p>Based on the radiological analysis, we identified 9 internal venous systems, accounting for variations in each analyzed structure. The statistical analysis revealed no differences in the frequency of subtypes between radiological and anatomical studies (<i>p</i> = 0.097), nor in the occurrence of false venous angles (<i>p</i> = 0.520). We identified venous configurations that, in our assessment, are unfavorable in the context of accessing the third ventricle.</p><h3>Conclusion</h3><p>The resulting classification accounts for significant clinical anatomical variations and, for the first time, provides specific morphometric values for each anatomical subtype. Consequently, it serves as a reproducible reference framework for preoperative planning of access to the third ventricle.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031752","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":"RADAR – Radiomics on aSDH: predicting outcome with surface area","authors":"Antonia Richter,&nbsp;Johannes Wach,&nbsp;Alim Basaran,&nbsp;Johannes Kasper,&nbsp;Florian Wilhelmy,&nbsp;Tim Wende,&nbsp;Felix Arlt,&nbsp;Ági Güresir,&nbsp;Erdem Güresir,&nbsp;Martin Vychopen","doi":"10.1007/s00701-024-06408-0","DOIUrl":"10.1007/s00701-024-06408-0","url":null,"abstract":"<div><h3>Background</h3><p>Acute subdural hematoma is a critical condition, leading to significant morbidity and mortality. Despite advancements in surgical techniques, a portion of patients only show limited clinical improvement post-evacuation. Surgical intervention decisions are critically important, as they can either improve or worsen a patient’s condition. Radiomics offers significant potential by extracting complex patterns from digital medical images and transforming them into high-dimensional data that reflect the underlying pathophysiology. By integrating Radiomics with individual patient characteristics, we can develop decision support models. This study aims to analyze radiomic parameters of aSDH to determine whether they support the decision to proceed with urgent surgery or opt for a conservative approach. We hypothesized that surface area could be a significant predictor of neurological outcome such as maintaining independent mobility (mRS ≥ 3) and survival rates.</p><h3>Methods</h3><p>This retrospective study involved radiomic analysis according to neurological outcome and survival. Radiomic parameters were measured using 3D Slicer software. Statistical analyses explored correlations, employing AUC-analysis and Kaplan-Meier survival.</p><h3>Results</h3><p>Our findings revealed significant correlations between hematoma and surface area with poorer neurological prognosis. Further subgroup analysis showed surface area as a significant predictor for poorer outcomes in patients undergoing craniotomy (<i>p</i> = 0.006 in univariant- and <i>p</i> = 0.020 in multivariant analysis). In the total cohort, among conservatively managed and craniotomy subgroups, survival analysis highlighted an advantageous survival for patients exhibiting smaller surface areas (&lt; 339.50 cm²).</p><h3>Conclusions</h3><p>Especially in craniotomy patients, surface area emerged as a possible predictor for neurological outcome and survival.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-024-06408-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142995086","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":"Assessing the subarachnoid space anatomy on clinical imaging: utilizing normal and pathology to understand compartmentalization of the subarachnoid space","authors":"Khaled Almohaimede,&nbsp;Yusuf Alibrahim,&nbsp;Abu Bakar Butt,&nbsp;Pejman Maralani,&nbsp;Chris Heyn,&nbsp;Anish Kapadia","doi":"10.1007/s00701-025-06428-4","DOIUrl":"10.1007/s00701-025-06428-4","url":null,"abstract":"<div><h3>Background</h3><p>The goal of the study is to use CT imaging in patients with aSAH to evaluate the anatomic distribution of hemorrhage and compartmentalization of subarachnoid space to investigate potential in vivo visualization of recently discovered layer named subarachnoid lymphatic-like membrane (SLYM).</p><h3>Methods</h3><p>We conducted a retrospective cohort study of cases with aneurysmal SAH (aSAH) at our institution between January 2015 and June 2022. Subarachnoid hemorrhage distribution into superficial and deep subarachnoid spaces was classified based on proximity to the dural or pial surfaces, respectively, as seen on multiplanar CT head.</p><h3>Results</h3><p>A total of 97 patients with aSAH were included. Patients with lower modified Fisher score (MFS) of 1-2 were more likely to have SAH compartmentalizing in the “deep” pial-adjacent subarachnoid space. Patients with higher MFS of 3-4 were more likely to have SAH in both “superficial” and “deep” compartments along the brainstem. There is a significant association between the severity of aSAH - quantified by the MFS - and the distribution of the blood. Patients with higher MFS scores were roughly 7.6 times (<i>p</i>-value = 0.049) more likely to have hemorrhage at the “Superficial” juxta-dural subarachnoid compartment when compared to those with lower MFS scores.</p><h3>Conclusion</h3><p>This study suggests an imaging correlate to the recently discovered “SLYM”, potentially influencing aSAH compartmentalization, particularly in low-grade bleeds. While compartmentalization is limited in high grade cases, these findings warrant further investigation with advanced imaging techniques to validate this membrane’s role and potential impact on CSF flow and aSAH pathophysiology. </p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06428-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142995035","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}