Acta Neurochirurgica最新文献

{"title":"How I do it: surgical techniques for vagus nerve stimulation in pediatric drug-resistant epilepsy","authors":"Santiago Ezequiel Cicutti,&nbsp;Javier F. Cuello,&nbsp;Guido P. Gromadzyn,&nbsp;Marcelo Bartuluchi","doi":"10.1007/s00701-025-06432-8","DOIUrl":"10.1007/s00701-025-06432-8","url":null,"abstract":"<div><h3>Background</h3><p>Vagus nerve stimulation (VNS) is a neuromodulatory treatment for refractory epilepsy, involving electrical stimulation of the vagus nerve via a subcutaneously implanted pulse generator.</p><h3>Method</h3><p>We present a step-by-step description of the VNS implantation technique, incorporating tips and tricks from an epilepsy surgeon with over 20 years of experience (MB).</p><h3>Conclusion</h3><p>Proper patient selection, meticulous surgical technique, and comprehensive postoperative care, supported by educational resources such as surgical technique articles, videos, and simulators, are crucial for minimizing complications and optimizing patient outcomes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06432-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143446627","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":"Three-dimensional amide proton transfer (APT) imaging appliable to navigation surgery can present comparable metabolic activity of glioblastoma to 11C-Methionine PET","authors":"Akihiro Inoue,&nbsp;Hideaki Watanabe,&nbsp;Kosuke Kusakabe,&nbsp;Masahiro Nishikawa,&nbsp;Sho Ohtsuka,&nbsp;Yasuhiro Shiraishi,&nbsp;Mashio Taniwaki,&nbsp;Yoshihiro Takimoto,&nbsp;Masaki Matsumoto,&nbsp;Mitsuharu Miyoshi,&nbsp;Seiji Shigekawa,&nbsp;Riko Kitazawa,&nbsp;Teruhito Kido,&nbsp;Takanori Ohnishi,&nbsp;Hisaaki Takahashi,&nbsp;Takeharu Kunieda","doi":"10.1007/s00701-025-06465-z","DOIUrl":"10.1007/s00701-025-06465-z","url":null,"abstract":"<div><h3>Background</h3><p>Amide proton transfer (APT) imaging has been proposed as a technique to assess tumor metabolic activity. We have previously ¹¹C-methionine positron emission tomography (¹¹C-Met-PET) can evaluate the metabolic activity of peritumoral area including infiltrating tumor cells in glioblastoma (GBM). To resolve disadvantages of ¹¹C-Met-PET, in the present study, we aimed to evaluate whether three-dimensional fast spin echo-based APT (3D FSE-APT) imaging is usable for not only presenting the metabolic activity of brain tumors, but also detecting areas where infiltrating tumor cells including glioma stem cells (GSCs) could exist, by applying an image-guided navigation system incorporating 3D FSE-APT to glioblastoma surgery.</p><h3>Methods</h3><p>Twenty-six consecutive patients with GBMs were enrolled in this study. Among these 26 cases, 10 patients underwent ¹¹C-Met-PET examination. All 26 patients underwent two-dimensional single shot fast spine echo-based APT acquisition with a chemical exchange saturation transfer sequence (2D SSFSE-APT). The most recent 14 cases underwent 3D FSE-APT to examine whether 3D APT imaging was applicable to the navigation system. We investigated the clinical applicability of 3D FSE-APT by comparison with 2D SSFSE-APT and evaluated the utility of 3D FSE-APT as a metabolic imaging guide in the intraoperative navigation system. We also analyzed whether 3D FSE-APT can depict the extent of infiltrating tumor cells including GSCs in the peritumoral area in GBM.</p><h3>Results</h3><p>The most recent 14 cases underwent 3D FSE-APT. The 3D FSE-APT was visually almost equivalent to 2D SSFSE-APT and mean APT intensity (APT_mean) in GBM obtained by 3D FSE-APT was almost equal to that from 2D SSFSE-APT. Mean APT_mean on 2D SSFSE-APT at the site showing a tumor-to-contralateral normal brain tissue ratio (TNR) of 1.4 on ¹¹C-Met-PET was 1.52 ± 0.16%. In contrast, mean APT_mean on 3D FSE-APT at the same site was 1.30 ± 0.06%. The optimal cut-off value for APT_mean on 3D FSE-APT was evaluated as 1.28%, offering 100% sensitivity and 100% specificity. Incorporating 3D FSE-APT into the navigation system allowed tumor resection including infiltrating tumor cells under image-guided navigation. Mean Ki-67 staining index in the area with a mean APT_mean of 1.28% was 11.8% (range, 5.0–20.0%).</p><h3>Conclusions</h3><p>The area of tumor invasion could be evaluated by 3D FSE-APT in a similar way to ¹¹C-Met-PET, and the cut-off value for deciding the borderline between the area including infiltrating tumor cells and that with almost no tumor cells was 12.8%. In addition, 3D FSE-APT could be applied to navigation systems and may have great potential as an imaging modality replacing ¹¹C-Met-PET in GBM surgery.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06465-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143446450","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":"Obituary Acad. Prof. Dr. Vinko V. Dolenc 1940 - 2025","authors":"Roman Bošnjak","doi":"10.1007/s00701-025-06444-4","DOIUrl":"10.1007/s00701-025-06444-4","url":null,"abstract":"","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06444-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404186","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":"Fully endoscopic combined endonasal and supraorbital keyhole approach for tuberculum sellae meningiomas with marked lateral extension: How I do it","authors":"Takeshi Hongo,&nbsp;Shunsuke Shibao,&nbsp;Yusuke Morinaga,&nbsp;Hiroyoshi Akutsu","doi":"10.1007/s00701-025-06458-y","DOIUrl":"10.1007/s00701-025-06458-y","url":null,"abstract":"<div><h3>Background</h3><p>The fully endoscopic combined endonasal and supraorbital keyhole approach, which integrates the endoscopic endonasal approach (EEA) and the endoscopic supraorbital keyhole approach (eSKA), is effective for complex suprasellar tumors extending beyond the internal carotid artery (ICA). We detail its application for tuberculum sellae meningiomas with lateral extension.</p><h3>Method</h3><p>Tumor resection is performed via the EEA, with support from the eSKA. This allows for careful management of the optic nerve under direct visualization and enables sufficient tumor resection.</p><h3>Conclusion</h3><p>This combined approach facilitates extensive tumor resection, effective skull base reconstruction, and preservation of surrounding structures.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06458-y.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404185","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 effect of music interventions compared to standard-of-care on the prevention of delirium in neurosurgical patients: an analysis of costs and cost-effectiveness based on the MUSYC-trial","authors":"Thomas L.A. Dirven,&nbsp;Pablo R. Kappen,&nbsp;Frederike Ten Harmsen van der Beek,&nbsp;Bronno van der Holt,&nbsp;Hans Jeekel,&nbsp;Clemens M.F. Dirven,&nbsp;Arnaud J.P.E. Vincent,&nbsp;Markus Klimek,&nbsp;Marten J. Poley","doi":"10.1007/s00701-025-06448-0","DOIUrl":"10.1007/s00701-025-06448-0","url":null,"abstract":"<div><h3>Background</h3><p>Postoperative delirium is a frequent complication with negative consequences for neurosurgical patients. Recorded music has been shown to reduce the incidence of delirium, however its economic benefit remains unclear. This study aimed to investigate the cost-effectiveness of perioperative music in preventing postoperative delirium.</p><h3>Methods</h3><p>This study used data from a randomized controlled trial (Clinical Trials.gov; NCT04649450) that compared the effect of perioperative music with standard of clinical care on the occurrence of postoperative delirium in patients undergoing craniotomy at the Erasmus Medical Centre. The primary outcome of this study is the cost-effectiveness of the music intervention. A trial-based cost-effectiveness analysis (CEA) was conducted from a societal perspective. Mean costs were calculated using bootstrapping with 95% confidence intervals. Secondary outcomes included postoperative complications, mortality, cognitive functioning, and quality of life. Costs and patient outcomes were assessed separately for the initial hospital admission and long-term follow-up until 6 months after discharge.</p><h3>Results</h3><p>This study included 91 patients in the intervention group and 93 in the control group. On average, medical costs during initial admission were lower, albeit not statistically significant, in the music group compared to the control group (€ 11,819 vs. € 13,106), mostly due to a shorter length of stay. Total costs over the 6-month period were nearly identical between the groups, at € 18,587 and € 18,571 in the music and control group, respectively.</p><h3>Conclusions</h3><p>Pre-recorded perioperative music may be a cost-effective intervention for reducing postoperative delirium in neurosurgical patients, possibly by decreasing healthcare utilization and costs during primary admission. Further studies are needed to confirm its potential as a cost-effective intervention.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06448-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143404188","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":"Treatment of small intracranial aneurysms using the SMALLSS scoring system: a novel system for decision making","authors":"Mira Salih,&nbsp;Michael Young,&nbsp;Thomas B Fodor,&nbsp;Alexander Andreev,&nbsp;Samuel D. Pettersson,&nbsp;Joanna M. Roy,&nbsp;Basel Musmar,&nbsp;Max Shutran,&nbsp;Phillip Taussky,&nbsp;Christopher S. Ogilvy","doi":"10.1007/s00701-025-06453-3","DOIUrl":"10.1007/s00701-025-06453-3","url":null,"abstract":"<div><h3>Background</h3><p>Treatment of unruptured intracranial aneurysms (UIA) less than 7 mm is controversial. We created a scoring system to guide decision making and validated the system utilizing over 700 cases treated with microsurgery or endovascular procedures.</p><h3>Methods</h3><p>The scoring system SMALLSS included Size, (4–7 mm: 1 point, &lt; 3.9 mm: 0 point), Multiple aneurysms (yes: 1, no: 0), <b>A</b>natomic location (posterior: 1, anterior: 0), Lineage- family history of aneurysm (yes:1, no: 0), Lifetime risk (age &lt; 65: 1, age &gt; 65: 0), <b>S</b>moking history (yes: 1, no: 0 ), <b>S</b>hape (irregular:1, smooth:0 ). Validation of this system was performed through retrospective review of prospectively maintained data for UIA patients treated between 2014 and 2021. We then performed an external validation of a cohort of 200 small aneurysms &lt; 7 mm treated at a high volume cerebrovascular center.</p><h3>Results</h3><p>A total of 1152 cases with unruptured intracranial aneurysms were treated over the study interval, of which 771 aneurysms (66.9%) were under 7 mm, with the majority (64.3%) having SMALLSS score more than 2. Serious neurologic complications occurred in 18 out of 771 aneurysms (2.33%) of which 4 were hemorrhagic and 14 were ischemic. The obliteration rate was 98% in microsurgery group, 89.7% in endovascular group. During this same interval, 1126 patients with aneurysms &lt; 7 mm were evaluated and not offered treatment, with 74.7% SMALLSS scores of 2 and under. External validation data showed no significant deviations from our cohort with 150 out of 200 aneurysms (75%) with a SMALLSS score of 2 or greater.</p><h3>Conclusion</h3><p>The SMALLSS scoring system can be a good tool to guide treatment decision making for patients with small UIA. The risk of treatment did not increase with the projected increased risk of rupture and overall high obliteration rates were achieved with endovascular and surgical techniques.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06453-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396687","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: surgical resection of micro-arteriovenous malformations","authors":"Sergio Corvino,&nbsp;A. Yohan Alexander,&nbsp;Giuseppe Lanzino","doi":"10.1007/s00701-025-06455-1","DOIUrl":"10.1007/s00701-025-06455-1","url":null,"abstract":"<div><h3>Background</h3><p>Micro-arteriovenous malformations (AVMs) are a subgroup of AVMs with a nidus smaller than 1- cm. As such, intraoperative localization of micro-AVMs can be challenging. Once identified intraoperatively, however, treatment of the micro-AVM is often straightforward.</p><h3>Method</h3><p>We discuss and illustrate the fundamental imaging and intraoperative steps to localize micro-AVMs with the aid of an illustrative clinical case.</p><h3>Conclusion</h3><p>Micro-AVMs can be challenging to localize intraoperatively. With the aid of anatomical, clinical, and intraoperative findings, the micro-AVMs small draining vein can be localized and traced in a retrograde fashion to identify and remove the micro-AVM.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06455-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396715","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: Tentorial meningioma resection with combination of 3D exoscope and endoscope via subtemporal approach","authors":"Licheng Zhang,&nbsp;Jinsen Zhang,&nbsp;Minjie Fu,&nbsp;Guo Yu,&nbsp;Wei Hua","doi":"10.1007/s00701-025-06456-0","DOIUrl":"10.1007/s00701-025-06456-0","url":null,"abstract":"<div><h3>Background</h3><p>Deep-seated brain tumors pose a distinctive neurosurgical challenge, as frequently surrounded by eloquent structures. 3D exoscope represents a potential new paradigm for mini-invasive neurosurgery, which shows advantage during the neurosurgical procedure for this kind of challenging cases.</p><h3>Methods</h3><p>Utilizing a combination of 3D exoscopes and endoscopes, we successfully removed a left tentorial meningioma in a patient <i>via</i> a subtemporal keyhole approach.</p><h3>Conclusion</h3><p>Combination of 3D exoscope and endoscope has the advantages of precise tissue identification, minimized brain traction and enhanced visibility in hidden areas by integrating the strengths of both.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06456-0.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396554","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":"Causal inference from observational data in neurosurgical studies: a mini-review and tutorial","authors":"Mingxuan Liu,&nbsp;Xinru Wang,&nbsp;Jin Wee Lee,&nbsp;Bibhas Chakraborty,&nbsp;Nan Liu,&nbsp;Victor Volovici","doi":"10.1007/s00701-025-06450-6","DOIUrl":"10.1007/s00701-025-06450-6","url":null,"abstract":"<div><h3>Background:</h3><p>Establishing a causation relationship between treatments and patient outcomes is of essential importance for researchers to guide clinical decision-making with rigorous scientific evidence. Despite the fact that randomized controlled trials are widely regarded as the gold standard for identifying causal relationships, they are not without its generalizability and ethical constraints. Observational studies employing causal inference methods have emerged as a valuable alternative to exploring causal relationships.</p><h3>Methods:</h3><p>In this tutorial, we provide a succinct yet insightful guide about identifying causal relationships using observational studies, with a specific emphasis on research in the field of neurosurgery.</p><h3>Results:</h3><p>We first emphasize the importance of clearly defining causal questions and conceptualizing target trial emulation. The limitations of the classic causation framework proposed by Bradford Hill are then discussed. Following this, we introduce one of the modern frameworks of causal inference, which centers around the potential outcome framework and directed acyclic graphs. We present the obstacles presented by confounding and selection bias when attempting to establish causal relationships with observational data within this framework.</p><h3>Conclusion:</h3><p>To provide a comprehensive overview, we present a summary of efficient causal inference methods that can address these challenges, along with a simulation example to illustrate these techniques.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06450-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388855","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":"Two-stage surgical strategy for extensive craniofacial fibrous dysplasia with cerebral compression","authors":"Ludovica Pasquini,&nbsp;Chandrima Biswas,&nbsp;Marcus Zachariah,&nbsp;Daniel M. Prevedello","doi":"10.1007/s00701-025-06438-2","DOIUrl":"10.1007/s00701-025-06438-2","url":null,"abstract":"<div><h3>Background</h3><p>The management of extensive craniofacial fibrous dysplasia requires balancing the extent of resection with the perioperative morbidity and complications.</p><h3>Method</h3><p>The authors describe a case involving the resection of extensive craniofacial fibrous dysplasia performed in two stages. The first surgery aims on removing most of the lesion and planning for bony reconstruction, while the second stage focuses to complete disease removal and implant a custom-made prosthesis.</p><h3>Conclusion</h3><p>This case highlights the benefits of a two-stage surgical approach in reducing morbidity compared to a single extensive surgery while achieving excellent disease resection and functional outcomes.</p></div>","PeriodicalId":7370,"journal":{"name":"Acta Neurochirurgica","volume":"167 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s00701-025-06438-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143388854","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}