Acta Neurochirurgica最新文献

{"title":"Tumour volume as a predictor of postoperative speech impairment in children undergoing resection of posterior fossa tumours: a prospective, multicentre study","authors":"Aske Foldbjerg Laustsen,&nbsp;Shivaram Avula,&nbsp;Jonathan Grønbæk,&nbsp;Barry Pizer,&nbsp;Per Nyman,&nbsp;Pelle Nilsson,&nbsp;Radek Frič,&nbsp;Magnus Aasved Hjort,&nbsp;Vladimír Beneš,&nbsp;Peter Hauser,&nbsp;Beatrix Pálmafy,&nbsp;Giedre Rutkauskiene,&nbsp;Florian Wilhelmy,&nbsp;Rick Brandsma,&nbsp;Astrid Sehested,&nbsp;René Mathiasen,&nbsp;Marianne Juhler","doi":"10.1007/s00701-025-06459-x","DOIUrl":"10.1007/s00701-025-06459-x","url":null,"abstract":"<div><h3>Background</h3><p>Cerebellar Mutism Syndrome (CMS) is a neurological complication of posterior fossa (PF) tumour surgery in children, and postoperative speech impairment (POSI) is the cardinal symptom of CMS. The role of tumour volume on the risk of POSI remains unexplored. This study investigates the association between tumour volume and the risk of POSI.</p><h3>Methods</h3><p>We included 360 patients from the European CMS study with available preoperative T1-weighted contrast-enhanced brain MRI. Speech status was assessed within two weeks postoperatively and categorised into three levels: habitual speech, severely reduced speech, and mutism. Tumour volumes were calculated using the BrainLab Elements SmartBrush™, a semi-automated segmentation tool. We used proportional odds models to estimate the odds ratio (OR) with adjustments for tumour location, pathology, and age. Based on the primary analysis, a risk stratification model for medulloblastoma patients was constructed, and the optimal volume cut-off was determined with Youden’s Index.</p><h3>Results</h3><p>We found no effect of the overall tumour volume on the risk of POSI. This result did not change when adjusted for tumour location, pathology, and age. We found an association between tumour volume of medulloblastoma and the risk of POSI (unadjusted OR of 1.04 per increase in cm³ (95% CI 1.01;1.07, <i>p</i> = <i>0.01</i>)), which did not change when adjusting for tumour location and age. The risk stratification cut-off for the tumour volume of medulloblastoma was calculated to be 16,5 cm³. Patients with medulloblastoma and preoperative tumour volumes below 16,5 cm³ had an absolute risk of 13% for POSI (low-risk group), whereas patients with preoperative tumour volumes above 16,5 cm³ had an absolute risk of 50% for POSI (high-risk group).</p><h3>Conclusion</h3><p>Our data showed an association between preoperative tumour volume and the risk of POSI in children with medulloblastoma, while no association was found for the volume of other tumour types. We suggest a straightforward cut-off risk model for assessing the risk of POSI in children with medulloblastoma based on preoperative tumour volume. This approach can aid clinicians in informing patients and parents about the complications related to CMS following PF tumour surgery in children.</p><h3>Clinical Trials</h3><p>ID NCT02300766 (October 2014).</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06459-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143761668","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":"Expandable grid, a simple, readily available and precise technique for intraoperative stereotactic real-time imaging","authors":"Dirar Aldabek,&nbsp;Andreas Hodul,&nbsp;François Alesch","doi":"10.1007/s00701-025-06505-8","DOIUrl":"10.1007/s00701-025-06505-8","url":null,"abstract":"<div><h3>Introduction</h3><p>Pre- and postoperative imaging constitutes a firm brick in planning and steering accurate stereotactic procedures. The availability of intraoperative control measures, e.g., CT, MRI, and microelectrode recording (MER), is often limited to a minority of centers. Our approach utilizes fluoroscopy for target planning and coordinates validation as control.</p><h3>Methods</h3><p>This technique was primarily conceived for the RM (Riechert Mundinger) stereotactic system, but it also applies to the ZD (Zamorano—Dujovny) system. In the present study, we shifted the zero of the Z-value (axis of the patient) to + 60 mm. This corresponds to the center of the Angio/X-ray localizing plates. By assigning a radiopaque marker to the center of each plate, aligning these centers produced orthogonal and non-distorted stereotactic space. In this space, the magnification variable matters to us the most. Using available viewer software, we printed a millimetric grid on translucent foils with the corresponding magnification factor, which can easily be superimposed on the fluoroscopic image. This allows the precise validation of the coordinates of points of interest, including typical stereotactic landmarks. This technique can be used in both views, AP and lateral.</p><h3>Results</h3><p>We have validated this technique under non-clinical (phantom) conditions and with intraoperative images obtained during routine stereotactic procedures. The latter were acquired using our classical stereotactic fixedly-mounted X-ray system. We found identical results, with an accuracy margin of error lower than 1 mm.</p><h3>Conclusion</h3><p>This simple geometrical adaptation proved to be an accurate, accessible, mobile, and manageable technique providing immediate access to stereotactic coordinates during surgery. The accuracy proved to be non-inferior to other more complex and time-consuming imaging modalities.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06505-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143749135","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":"Full dose of cangrelor in the acute treatment of small ruptured cerebral aneurysms with flow diverters: a single center experience","authors":"Giuseppe Pelle,&nbsp;Alessandro Onori,&nbsp;Flavio Andresciani,&nbsp;Massimo Messina,&nbsp;Alessandro Tanzilli,&nbsp;Ermanno Notarianni,&nbsp;Adelchi Saltarelli,&nbsp;Roberta Siniscalchi,&nbsp;Andrea Pietrantonio,&nbsp;Giada Toccaceli,&nbsp;Angelo Pompucci,&nbsp;Cesare Ambrogi","doi":"10.1007/s00701-025-06504-9","DOIUrl":"10.1007/s00701-025-06504-9","url":null,"abstract":"<div><h3>Purpose</h3><p>This article aims to retrospectively assess the safety, efficacy and feasibility of using intravenous cangrelor in the acute treatment of small ruptured cerebral aneurysms (less than 6 mm) with FD, discussing its potential advantages over traditional antiplatelet agents and its implication on clinical practice.</p><h3>Methods</h3><p>This is a single-center retrospective study conducted on patients who underwent emergency FD implantation for hemorrhagic stroke due to acute rupture of intracranial aneurysms between January 2020 and February 2024. Patients were medicated with cangrelor in association with acetylsalicylic acid (ASA) before stent deployment. All patients were treated within 5 h from hospital arrival and received intravenous cangrelor (30 µg/kg administered over less than 1 min) + ASA (300 mg), followed by an infusion of cangrelor at 4 µg/kg/minute for either 12 or 24 h, as per clinical scenario. Procedural complications related to antiplatelet therapy itself, rate of complete aneurysm occlusion at 12-months follow-up and clinical outcome in terms of functional scale (mRS) were evaluated.</p><h3>Results</h3><p>Ten patients were retrospectively evaluated. The interventions showed a favorable outcome with no reported thromboembolic or hemorrhagic complications within the first 24 h post-procedure. Six out of ten patients (60%) of patients had a good clinical prognosis (mRS 0–2), and MRA/CTA follow-ups indicated a complete resolution of aneurysms in the majority of cases (five out of seven patients (71.5%) occlusion rate at 12 months).</p><h3>Conclusion</h3><p>In our limited experience, cangrelor has proven to be safe and effective in preventing thromboembolic complications after acute FD implantation for ruptured intracranial aneurysms; further studies with larger populations and comparative methodologies are required to incorporate cangrelor into standard neurovascular practice.</p><h3>Graphical abstract</h3>\u0000<div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06504-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143740850","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":"Image quality assessment in spine surgery: a comparison of intraoperative CBCT and postoperative MDCT","authors":"Paulina Cewe,&nbsp;Mikael Skorpil,&nbsp;Alexander Fletcher-Sandersjöö,&nbsp;Victor Gabriel El-Hajj,&nbsp;Per Grane,&nbsp;Michael Fagerlund,&nbsp;Magnus Kaijser,&nbsp;Adrian Elmi-Terander,&nbsp;Erik Edström","doi":"10.1007/s00701-025-06503-w","DOIUrl":"10.1007/s00701-025-06503-w","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate if intraoperative cone-beam CT (CBCT) provides equivalent image quality to postoperative multidetector CT (MDCT) in spine surgery, potentially eliminating unnecessary imaging and cumulative radiation exposure.</p><h3>Methods</h3><p>Twenty-seven patients (16 men, 11 women; median age 39 years) treated with spinal fixation surgery were evaluated using intraoperative CBCT and postoperative MDCT. The images were independently evaluated by four neuroradiologists, utilizing a five-step Likert scale and visual grading characteristics (VGC) analysis. The area under the VGC curve (AUC_VGC) quantified preferences between modalities. Intra- and inter-observer variability was evaluated using intraclass correlation coefficients (ICC). Image quality was objectively evaluated by contrast and signal-to-noise measurements (CNR, SNR).</p><h3>Results</h3><p>In image quality, CBCT was the preferred modality in thoracolumbar spine (AUC_VGC = 0.58, <i>p</i> &lt; 0.001). Conversely, MDCT was preferred in cervical spine (AUC_VGC = 0.38, <i>p</i> &lt; 0.004). The agreement was good for inter-observer and moderate in intra-observer (ICC 0.76—0.77 vs 0.60—0.71), <i>p</i> &lt; 0.001. SNR and CNR were comparable in thoracolumbar imaging, while MDCT provided superior and more consistent image quality in the cervical spine, <i>p</i> &lt; 0.001.</p><h3>Conclusion</h3><p>In spine surgery, CBCT provides superior image quality for thoracolumbar imaging, while MDCT performs better for cervical imaging. Intraoperative CBCT could potentially replace postoperative MDCT in thoracolumbar spine procedures, while postoperative MDCT remains essential for cervical spine assessment.</p><h3>Key Points</h3>\u0000<ul>\u0000 <li>\u0000 <p>Subjective assessment demonstrated that CBCT was the preferred modality for thoracolumbar spine imaging, while MDCT was favored for cervical spine imaging.</p>\u0000 </li>\u0000 <li>\u0000 <p>Agreement between readers was good, while individual readings showed moderate consistency in repeated assessments.</p>\u0000 </li>\u0000 <li>\u0000 <p>Objective assessment of image clarity and detail showed both modalities performed equally well in the thoracolumbar spine, while MDCT performed better in the cervical spine.</p>\u0000 </li>\u0000 <li>\u0000 <p>Intraoperative CBCT proves superior to postoperative MDCT for thoracolumbar spine imaging, potentially eliminating redundant scans, and improving workflow. Postoperative MDCT remains essential for cervical spine procedures.</p>\u0000 </li>\u0000 </ul></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06503-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143740860","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":"Robotic assisted free flap reconstruction of the scalp using the Symani® surgical system","authors":"Jennifer Ashley Watson,&nbsp;Sören Könneker,&nbsp;Giuseppe Esposito,&nbsp;Luzie Hofmann,&nbsp;Bong-Sung Kim,&nbsp;Pietro Giovanoli,&nbsp;Nicole Lindenblatt","doi":"10.1007/s00701-025-06501-y","DOIUrl":"10.1007/s00701-025-06501-y","url":null,"abstract":"<div><h3>Purpose</h3><p>Robotic-assisted surgery currently is evolving as a new field in microsurgery with potential benefits for reconstructive surgery. The Symani^® Surgical System has shown feasibility in performing microsurgical anastomosis. Reconstruction of the soft tissue of the scalp is commonly necessary after brain surgery with reconstruction of the cranium using foreign materials such as PEEK (Polyether ether ketone). We describe our experience with free soft tissue transfer with a free anterolateral thigh (ALT) flap or free latissimus dorsi (LD) flap for reconstruction of the scalp using the Symani^® Surgical System for microsurgical anastomosis.</p><h3>Methods</h3><p>We analyzed 6 patients with soft tissue defects of the scalp from September 2023 to January 2024 undergoing soft tissue reconstruction with a free ALT or LD flap. Robotic-assisted microsurgical anastomoses were performed using the Symani^® Surgical System.</p><h3>Results</h3><p>4 male patients and 2 female patients (age 61-81 years, mean 71.8 years) were included. Mean hospital stay was 10 (8-13) days. The most common recipient vessels were the Superficial temporal artery and vein (66.7%). In other cases, we used the facial artery and vein. All arterial anastomoses were performed by using the Symani^® Surgical System. The mean operative time was 387 (328-48) minutes. The mean anastomosis time using the Symani^® Surgical System was 32.5 (19-44) minutes. No flap loss was observed. One patient suffered from a PEEK infection as a delayed post-operative complication.</p><h3>Conclusion</h3><p>For reconstruction of soft tissue defects of the scalp, a free ALT or LD flap represents a proper treatment option. Performing microanastomosis using the Symani^® Surgical System is a safe technology and is leading to satisfactory outcomes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06501-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143726752","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":"Indocyanine green fluorescence in endoscopic transsphenoidal resection of pituitary neuroendocrine tumors: a systematic review","authors":"Ida Olesrud,&nbsp;Ingeborg Janshaug Halvorsen,&nbsp;Marit Aarvaag Storaker,&nbsp;Ansgar Heck,&nbsp;Daniel Dahlberg,&nbsp;Markus K. H. Wiedmann","doi":"10.1007/s00701-025-06500-z","DOIUrl":"10.1007/s00701-025-06500-z","url":null,"abstract":"<div><h3>Background</h3><p>Over the last decade, endoscope integrated indocyanine green (E-ICG) fluorescence has been introduced in endoscopic skull base surgery. E-ICG seems to be a promising tool for intraoperative tissue differentiation, distinguishing pituitary neuroendocrine tumors (PitNET) from pituitary gland. More recent technical advancements have made E-ICG with simultaneous near-infrared/white-light overlay imaging available. E-ICG may improve intraoperative tumor identification, enabling more precise surgery and ultimately improved patient outcome. This systematic review evaluates the use of E-ICG for PitNET surgery.</p><h3>Methods</h3><p>A systematic review was performed in accordance with PRISMA guidelines. PubMed, EMBASE, MedLine and Scopus databases were searched using different terms for “pituitary adenoma” combined with “Indocyanine green”. Data from relevant original papers were extracted and analyzed.</p><h3>Results</h3><p>Fifteen studies were included in the final analysis. The studies employed different ICG administration and fluorescence assessment protocols. Endpoints and methodology were heterogenous. Study populations varied from one to 39 cases. A total of 193 patients underwent transsphenoidal endoscopic surgery with E-ICG for PitNET. ICG dosage varied from 5 mg to 25 mg/kg. Thirteen studies administered ICG intraoperatively. Eleven studies utilized first-generation endoscopes, requiring toggling between near infrared light fluorescence and white light. Second generation dual or overlay mode endoscopes were used in four studies. Tumor fluorescence was assessed in eleven studies (141 cases). Six studies utilized a quantitative method to assess ICG-fluorescence. Seven studies specifically reported surgical complications. No safety issues regarding ICG use were reported.</p><h3>Conclusions</h3><p>The current literature is mainly based on small single center cohorts and case-studies, presenting a wide variety of approaches. Procedures and intraoperative assessment of fluorescence were mainly performed utilizing first-generation ICG endoscopes. There is lack of consensus in terms of ICG as an intraoperative tumor marker. Endoscopic ICG seems a promising tool for intraoperative real-time tissue differentiation, including vascular structures, tumor and pituitary gland.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06500-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143726689","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 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;Bing Tang","doi":"10.1007/s00701-025-06498-4","DOIUrl":"10.1007/s00701-025-06498-4","url":null,"abstract":"<div><h3>Objective</h3><p>This study aims to evaluate the clinical significance of multiple intraoperative sterilizations and bacteriological surveillance in reducing postoperative intracranial infections during transnasal endoscopic skull base surgery.</p><h3>Methods</h3><p>This study collected clinical data from 1002 patients undergoing transnasal endoscopic skull base surgery between January 2016 and January 2024. Patients were divided into a routine sterilization group (367 patients) and a multiple sterilization group (635 patients) based on the sterilization method. The rates of intracranial infections were compared between the two groups. Additionally, intraoperative bacteriological monitoring before and after sterilization was performed on some patients in the multiple sterilization group to analyze bacterial colonization and its relationship with intracranial infections.</p><h3>Results</h3><p>In the routine sterilization group of 367 patients, 21 patients (5.72%) developed intracranial infections. Of these, 20 patient had cerebrospinal fluid leakage during surgery. In the multiple sterilization group of 635 patients, 14 patients (2.20%) developed intracranial infections, all associated with cerebrospinal fluid leakage during surgery. Among the 96 patients who underwent bacteriological monitoring, 59 patients and 11 patients had definitive positive bacterial cultures before and after nasal disinfection, respectively. Additionally, 18 patients and 5 patients had definitive positive bacterial cultures before and after sphenoid sinus disinfection, respectively. One patient developed an intracranial infection caused by the same pathogens cultured from the nasal cavity.</p><h3>Conclusion</h3><p>Most pathogenic bacteria causing postoperative intracranial infections in patients undergoing transnasal endoscopic skull base surgery originate from nasal colonization. Multiple intraoperative sterilizations can reduce the incidence of intracranial infections in patients with high-risk factors for intraoperative cerebrospinal fluid leakage.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06498-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698690","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 time course of alpha 2-plasmin inhibitor and plasmin-alpha 2-plasmin inhibitor complex levels in patients with traumatic brain injury","authors":"Takahiro Kanaya,&nbsp;Ryuta Nakae,&nbsp;Tetsuro Sekine,&nbsp;Yu Fujiki,&nbsp;Yasuhiro Takayama,&nbsp;Yutaka Igarashi,&nbsp;Go Suzuki,&nbsp;Yasutaka Naoe,&nbsp;Hiroyuki Yokota,&nbsp;Shoji Yokobori","doi":"10.1007/s00701-025-06496-6","DOIUrl":"10.1007/s00701-025-06496-6","url":null,"abstract":"<div><h3>Background</h3><p>In its acute phase, traumatic brain injury (TBI) is notable for disturbances in the coagulation/fibrinolysis system. Plasmin, alpha 2-plasmin inhibitor (α2-PI), and their complex (plasmin-α2-PI complex [PIC]) are important components of the coagulation-fibrinolytic system, but their time courses in the acute phase of TBI and their association with long-term prognosis are unknown.</p><h3>Methods</h3><p>We conducted a retrospective analysis of 84 consecutive patients with isolated TBI, during which plasma α2-PI and PIC levels were measured at the time of arrival, as well as at 3, 6, and 12 h, and on days 1, 3, and 7 post-injury. Differences in plasma α2-PI and PIC levels between the good outcome group (extended Glasgow Outcome Scale [GOS-E] of 5–8 at 6 months post-injury) and the poor outcome group (GOS-E of 1–4 at 6 months post-injury) were analyzed using a generalized linear mixed model (GLMM). The hematoma volume of the initial CT scan upon admission and the follow-up CT scan was evaluated using CT volumetry, and then the relationship between changes in hematoma volume and plasma levels of α2-PI and PIC at admission was examined.</p><h3>Results</h3><p>Abnormally high plasma PIC levels were observed at admission in 97.6% of the patients. In the GLMM adjusted for covariates, the poor outcome group had significantly lower plasma α2-PI activity from admission to 3 days post-injury and significantly higher plasma PIC levels from admission to 6 h post-injury compared to the good outcome group. A negative correlation was found between α2-PI activity at admission and changes in hematoma volume (Spearman’s correlation coefficient, <i>r</i> =  − 0.587, <i>p</i> = 0.001).</p><h3>Conclusions</h3><p>These findings suggest that plasmin was activated and fibrinolysis enhanced immediately after injury in most patients, while in a subset of patients, hematoma expansion due to the suppression of fibrinolytic inhibition by α2-PI negatively affected the outcome.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06496-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143688496","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 I do it: Selective femoral neurotomy","authors":"Pierre Petitet,&nbsp;Corentin Dauleac,&nbsp;Camilla de Laurentis,&nbsp;Patrick Mertens","doi":"10.1007/s00701-025-06466-y","DOIUrl":"10.1007/s00701-025-06466-y","url":null,"abstract":"<div><h3>Background</h3><p>Quadriceps spasticity is responsible for a gait disturbance characterized by stiff knee with reduced knee flexion during the swing phase. Selective Femoral Neurotomy induces long-term muscle relaxation via a decrease of the stretch reflex.</p><h3>Method</h3><p>Femoral nerve trunk is dissected just below the femoral crease. Motor branches to the rectus femoris and/or vastus intermedius muscles are identified using electrical stimulation combined with electromyographic recording, then partially sectioned according to an individualized preoperative chart. Postoperative rehabilitation is imperative for sustained gait improvements.</p><h3>Conclusion</h3><p>Selective Femoral Neurotomy (SFN) is a lesion-based, permanent surgical treatment of spastic stiff knee gait.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06466-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143688497","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-assisted contralateral interhemispheric transfalcine keyhole approach for falcine meningioma: How I do it","authors":"Kouko Fujiwara,&nbsp;Shunsuke Shibao,&nbsp;Ryota Sasao,&nbsp;Masaaki Nishimoto","doi":"10.1007/s00701-025-06497-5","DOIUrl":"10.1007/s00701-025-06497-5","url":null,"abstract":"<div><h3>Background</h3><p>Although the ipsilateral craniotomy approach has been used for the removal of falcine meningioma (FM), we report a case of FM that was minimally invasively removed using a contralateral interhemispheric approach assisted with endoscopy.</p><h3>Methods</h3><p>We used a contralateral approach with a small craniotomy of the FM. The tumor was detached from the surrounding tissue during internal decompression. It was dissected and coagulated endoscopically in a blind spot under a microscope, and a Simpson Grade I resection was achieved.</p><h3>Conclusion</h3><p>A small craniotomy with a contralateral interhemispheric approach assisted by endoscopy allowed minimally invasive tumor removal without complications.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06497-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676319","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}