Neurocirugia (English Edition)最新文献

{"title":"Endoscopic 360° Vision of the Orbit: A Comparative Anatomical Study of Endonasal and Transorbital Approaches.","authors":"D Gagliano, R Manfrellotti, N Lasunin, A Prats-Galino, A DI Somma, J Enseñat","doi":"10.1016/j.neucie.2025.500704","DOIUrl":"https://doi.org/10.1016/j.neucie.2025.500704","url":null,"abstract":"<p><strong>Background and objective: </strong>Treatment of lesions located within and surrounding the orbit pose considerable surgical challenges, due to the presence of critical neurovascular structures in such deep, confined spaces. Historically, transcranial and craniofacial approaches have been widely used to deal with orbital pathologies. However, in recent decades we have witnessed the emergence of minimally invasive techniques to reduce morbidity and hospitalization times. Among these techniques are the endoscopic endonasal approach (EEA) and the subsequently developed endoscopic transorbital approach (ETOA). This anatomical study aims to compare and combine the surgical view offered by these two endoscopic pathways to achieve a circumferential access to the orbit.</p><p><strong>Methods: </strong>Anatomic dissections were performed at the Laboratory of Surgical Neuroanatomy (LSNA) of the Human Anatomy and Embryology Unit, University of Barcelona (Barcelona, Spain) on 5 cadaveric specimens (10 sides), whose arterial and venous systems were injected with red and blue latex respectively. Dissections were made with microsurgical instruments and a surgical endoscope.</p><p><strong>Results: </strong>After careful removal of the intraorbital fat, all the extraocular muscles were exposed and dissected, as well as the optic nerve, the ophthalmic artery, and the lacrimal gland. Special emphasis was given to dissecting the nerves' course from the cavernous sinus to their muscle innervation: Oculomotor and its branches, trochlear, abducent and ophthalmic nerve with its branches (frontal, nasociliary and lacrimal nerve). Each of the two endoscopic pathways provided a different perspective of the orbit and its structures. After both corridors were completed, a communication between the surgical pathways was highlighted, in a so-called connection area.</p><p><strong>Conclusions: </strong>The combination of the EEA and ETOA provides a 360° view of the orbit and its contents. The EEA offers an inferior and medial view of the orbit, through the lamina papyracea of the ethmoid in the first case and through the roof of the maxillary sinus in the latter. At the same time, the ETOA shows a lateral perspective, removing the lateral rim of the orbit, allowing great maneuverability inside the orbit and a wide visualization. This study provides a detailed overview of the surgical neuroanatomy of the orbit, which is an essential and didactic baseline in preparation for practical clinical applications. Overall, EEA and ETOA seem adequate to gain optimal exposure of the orbit and can be adapted to treat a wide range of pathologies. Yet, surgical case series are necessary to establish the true clinical value of these endoscopic approaches in orbital and peri-orbital surgery. However, the limited number of specimens analyzed (5 cadavers, 10 sides) must be acknowledged as a limitation.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500704"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epileptogenicity post Stereoelectroencephalography and Subdural Grids Invasive Monitoring: A Retrospective Analysis of Adult and Pediatric Patients with Refractory Epilepsy.","authors":"Sonia Pulido, Sven Ivankovic, Nolan Winslow, Andres Maldonado","doi":"10.1016/j.neucie.2025.500703","DOIUrl":"https://doi.org/10.1016/j.neucie.2025.500703","url":null,"abstract":"<p><strong>Objective: </strong>To assess if removal of stereoelectroencephalography (SEEG) or subdural grids (SDG) is associated with an increased seizure frequency in patients with refractory epilepsy during the immediate postoperative period.</p><p><strong>Methods: </strong>37 patients with refractory epilepsy that underwent monitoring with SEEG or SDG during November 2012 - March 2022 were identified using electronic medical records from a single institution. Seizure history, duration of intracranial monitoring, and monitored brain regions were recorded.</p><p><strong>Results: </strong>5.0% and 5.9% of SEEG and SDG patients had a seizure within 48 hours post-termination of monitoring. 25% and 11.8% of SEEG and SDG patients had a seizure between 48 hours and 1-week after surgery. Between 1 week and 1 month after SEEG or SDG removal, 35% and 41.2% of patients had a seizure. 30% and 50% SEEG or SDG patients had a seizure between 1- and 2-months following removal. Overall change in postoperative seizure frequency was not significant. Seizure frequency increased for 11.8% of SDG patients while frequency remained unchanged for 5.9% and decreased for 82.4%. No patients post-SEEG removal in our cohort experienced an increased seizure frequency. 95% experienced a decrease in seizure frequency and no change was observed in 5%.</p><p><strong>Conclusion: </strong>SEEG is not associated with increased epileptogenicity after termination of monitoring. Two patients post-SDG removal experienced an increase in seizure frequency. While patients with refractory epilepsy may continue to have seizures during the immediate postoperative period, it is likely that patients will experience a decrease in seizure frequency after removal of SEEG or SDG.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500703"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Arteriovenous Malformations in the Precentral and Postcentral Gyri on Intracranial Volumes.","authors":"Abdulkerim Gokoglu, Hüseyin Yiğit, Tolga Turan Dündar, Erdoğan Unur, Ahmet Selçuklu","doi":"10.1016/j.neucie.2025.500705","DOIUrl":"https://doi.org/10.1016/j.neucie.2025.500705","url":null,"abstract":"<p><strong>Objective: </strong>Arteriovenous malformations are known as arterial-venous shunts that connect nidus, the nourishing arteries, to draining veins. Although they are not very common in the brain, they are responsible for approximately 2% of all strokes. The volumetric changes in the surrounding brain tissues caused by cerebral arteriovenous malformations have not yet been reported.</p><p><strong>Methods: </strong>To detect these volumetric changes, MR data were acquired from 38 controls and 25 unoperated patients with arteriovenous malformations in the precentral and postcentral gyrus. MR data were analyzed with vol2Brain, Ceres and HIPS pipelines. The niduses of these patients were resected by transsulcal microsurgical dissection.</p><p><strong>Results: </strong>A comprehensive volumetric analysis encompassing 135 distinct brain, cerebellar, and hippocampal structures was conducted using the Vol2brain software. Comparison between the patient group and the control group revealed significant volumetric differences. Specifically, the patient group exhibited significantly larger volumes in the nucleus accumbens, fusiform gyrus, middle occipital gyrus, anterior insula, inferior lateral ventricle, and the grey matter of cerebellar lobules VIIIA and VIIIB compared with the control group. Conversely, relative to the control group, the patient group demonstrated significantly smaller volumes in the grey matter of cerebellar lobules IV, I-II, and III, as well as in the hippocampal subfields of CA2-CA3, SR-SL-SM, and the subiculum.</p><p><strong>Conclusion: </strong>Arteriovenous malformations occurring in the precentral and postcentral gyrus lead to volumetric changes in structures distant from the site of the malformation, including the brain, hippocampus, and even the cerebellum. Therefore, AVMs may influence the volumes of structures located not only within their immediate brain region but also in other parts of the cerebrum and cerebellum. Understanding these volumetric changes can aid in explaining patient symptoms. However, further research is required regarding whether these volumetric changes result from the mass effect of the nidus or stem from another underlying cause.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500705"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcranial Microsurgery as a Salvage Strategy in Giant Pituitary Adenomas: A Single-Center Experience and Long-Term Follow-up Results.","authors":"Oguz Altunyuva, Ali Imran Ozmarasali, Nur Balcin, Hanside Setenay Unal, Selcuk Yilmazlar","doi":"10.1016/j.neucie.2025.500699","DOIUrl":"10.1016/j.neucie.2025.500699","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic transsphenoidal surgery (ETSS) is the preferred approach for most pituitary adenomas. However, transcranial microsurgery remains relevant for giant adenomas with complex features. This study presents long-term outcomes and complications in a single-surgeon series of patients with giant pituitary adenomas who underwent transcranial resection.</p><p><strong>Material and methods: </strong>This retrospective study analyzed 29 patients with giant pituitary adenomas (≥4 cm) who underwent transcranial surgery between 2009 and 2018 at Bursa Uludağ University Faculty of Medicine. Inclusion criteria were: a minimum tumor diameter of 4 cm, histologically confirmed pituitary adenoma, tumor resection via a transcranial approach, regular postoperative follow-up, and a minimum follow-up of 60 months. Data collected included patient demographics, clinical presentation, tumor characteristics, surgical details, extent of resection, and long-term outcomes (minimum 60 months follow-up).</p><p><strong>Results: </strong>The mean patient age was 48.17 ± 12.92 years. Vision loss was the most common presenting symptom (n = 20). Gross total resection (GTR) was achieved in 51.7% (n = 15) and subtotal resection (STR) in 48.3% (n = 14). Postoperative improvement in visual function was observed in 48.3% (n = 14), while 20.7% (n = 6) experienced deterioration. Endocrinological remission occurred in 20.7% (n = 6). Complications included diabetes insipidus (24.13%, n = 7), cerebrovascular events (10.34%, n = 3), and mortality (17.24%, n = 5).</p><p><strong>Conclusions: </strong>Transcranial surgery for giant pituitary adenomas can achieve favorable outcomes in terms of tumor control and visual function improvement. However, it is associated with a risk of complications, including endocrinological and cerebrovascular events. Careful patient selection, meticulous surgical technique, and close postoperative monitoring are essential for optimizing outcomes. Transcranial microsurgery remains an important tool in the armamentarium of neurosurgeons managing complex giant pituitary adenomas.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500699"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Direct puncture embolization of intracranial solitary fibrous tumor with SQUID.","authors":"Dixit Varma, Avinash A Gutte, Snehal Kose, Abin Jose","doi":"10.1016/j.neucie.2025.500700","DOIUrl":"10.1016/j.neucie.2025.500700","url":null,"abstract":"<p><p>Solitary fibrous tumors (SFTs) are rare intracranial neoplasms that are highly vascular, making surgical resection challenging due to significant intraoperative blood loss. Preoperative embolization is commonly performed via the transarterial route; however, this approach has limitations, including difficulty in accessing multiple feeders, prolonged procedural time, and the risk of embolic material reflux into the intracranial circulation. Here, we report the case of a 19-year-old male with a large intracranial SFT, initially treated with transarterial embolization using polyvinyl alcohol (PVA) particles, which failed to achieve proper devascularization of the tumor. Consequently, direct puncture embolization using the SQUID 12 agent was performed. Following successful embolization, complete tumor resection was achieved with significantly reduced intraoperative blood loss and no postoperative neurological deficits. This case highlights the effectiveness of direct puncture embolization as a viable alternative to traditional transarterial approaches for managing highly vascular intracranial tumors.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500700"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The genesis of Academic Neurosurgery. Part I: The so-called \"Gestational Period\" and the contributions of Harvey Cushing.","authors":"Ramiro D Lobato, Alfonso Lagares, Pedro A Gómez López, José A F Alén, Pedro González León, Angel Pérez Núñez, Beatriz Pascual","doi":"10.1016/j.neucie.2025.500671","DOIUrl":"10.1016/j.neucie.2025.500671","url":null,"abstract":"<p><p>This is the first of five papers describing the origin and evolution of the so-called Academic Neurosurgery which will appear consecutively in the journal Neurocirugía. The three firsts focuse on the emergence of the specialty in Europe and the United States and its development in the last country between the origins and the present moment, paying special attention to the foundation of the neurosurgical societies (SNS, AANS, CNS) with their respective journals and the configuration of the residency programs. The fourth analyzes the same issues in Europe and, most specifically in Spain, also from the beginnigs to the XXI century. The fifth describes the development of Academic Neurosurgery in a neurosurgical unit of one of hospitals created by the National Social Security System in the early 1970s. The present paper describes the initiatives, difficulties and achievements of the pioneers at both sides of the Atlantic during the so called Gestational Period for creating the new and independent specialty of Neurosurgey conceived as a scientific and clínico-surgical activiy with an academic profil.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500671"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intradural anastomoses between the cervical spinal nerves: Anatomical study.","authors":"Matilde Lissarrague, Franklin Miranda Solís, Fernando Martínez Benia","doi":"10.1016/j.neucie.2025.500666","DOIUrl":"10.1016/j.neucie.2025.500666","url":null,"abstract":"<p><strong>Introduction: </strong>Peripheral nerves can present anastomoses at different levels, with intraspinal anastomoses being relatively common, but little studied.</p><p><strong>Objective: </strong>To study the presence and number of intradural anastomoses of the cervical spinal nerves in the Latin population.</p><p><strong>Materials and methods: </strong>14 adult corpses of both sexes were dissected, fixed in formaldehyde solution. Sex of the corpse, existence of anastomosis, side, height of the anastomoses and sensory/motor origin were recorded.</p><p><strong>Results: </strong>of the 14 corpses, 8 were male and 6 were female. Eleven cases presented anastomoses (79%), 8 of them bilaterally. In the total number of corpses, 52 anastomoses were found, 43 were between sensory roots (83%) and 9 between motor roots (17%). The levels where anastomoses were found most frequently were C1-C2 and C2-C3 (63% of the total).</p><p><strong>Discussion and conclusions: </strong>intraspinal anastomoses between motor or sensory nerves can vary the clinical presentation of spinal cord injuries, radicular or medullar compressions, brachial plexus lesions or nerve root tumors, because the sensory or motor information of a given spinal cord level may be exiting the neuraxis with the adjacent spinal nerve.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500666"},"PeriodicalIF":0.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image control after aneurysm clipping: Is 3D computed tomogram angiography enough?","authors":"Sebastián Menéndez-Girón, Antonio González-Crespo, Alberto Blanco Ibáñez de Opacua, Roser García-Armengol, Carlos J Dominguez, Ana Rodríguez-Hernández","doi":"10.1016/j.neucie.2025.500677","DOIUrl":"10.1016/j.neucie.2025.500677","url":null,"abstract":"<p><strong>Background: </strong>Cerebral digital subtraction angiography (DSA) remains the gold standard for the control of aneurysmal remnants after surgical clipping. Despite being associated with minimal risks, it is an invasive procedure far from being iatrogenia free. Furthermore, it has limited availability which may prolong patient's postoperative stay. On the other hand, the image quality of computed tomography angiography (CTA) has improved significantly over the past decades providing a valuable alternative to DSA. The objective of this study was to compare the capacity of CTA and DSA to detect clinically significant aneurysmal remnants.</p><p><strong>Methods: </strong>From a prospective series of surgically treated aneurysms, those with postoperative CTA and DSA were retrospectively included in the study. A three-dimensional reconstruction of the CTA was performed using the Brainlab Elements software and the results were compared with those of the DSA. In addition, variables that could affect the three-dimensional reconstruction were collected, such as the number of clips per aneurysm and previous clipping or embolization. In case of an aneurysm remnant, its size was also recorded.</p><p><strong>Results: </strong>Between January 2020 and January 2022, a total of 42 patients in whom 52 aneurysms were clipped (8 of them ruptured) were included. CTA presented a sensitivity of 50% and a specificity of 97% in the detection of aneurysmal remnants. The cases in which CTA did not detect the aneurysmal remnant were previously embolized aneurysms or complex aneurysms that required neck reconstruction with 3 or more clips. None of the remnants undetected by CTA were significant enough to warrant retreatment of the aneurysm.</p><p><strong>Conclusions: </strong>Excluding complex aneurysms (previously embolized or requiring surgical reconstruction with 3 or more clips), three-dimensional reconstructions of CTA images showed excellent results in detecting clinically significant postoperative aneurysm remnants and may obviate the need for a the more invasive and less available DSA.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500677"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is monopolar electrocautery use in vagus nerve stimulator revision surgery a risk to avoid or a safe surgical option?","authors":"Cezmi Çağrı Türk, Umut Ogün Mutlucan, Orhan Günay, Fatma Genç, Meltem Korucuk, Gültekin Kutluk","doi":"10.1016/j.neucie.2025.500674","DOIUrl":"10.1016/j.neucie.2025.500674","url":null,"abstract":"<p><strong>Background: </strong>The use of monopolar electrocautery in vagal nerve stimulator (VNS) revision surgeries has been debated due to concerns about device interference. Thus, herein, we aimed to evaluate the safety and efficacy of monopolar electrocautery during VNS generator replacement surgeries, particularly its impact on seizure control and battery performance.</p><p><strong>Methods: </strong>A retrospective observational study was conducted on 30 patients who underwent VNS generator revision at a tertiary care center. Patients were divided into two groups: those in whom monopolar electrocautery was used (n = 18) and those in whom it was not used (n= = 12). Pre- and postoperative data were collected, including seizure frequency, VNS settings, and operative time. The McHugh Outcome Classification was used to assess seizure control.</p><p><strong>Results: </strong>The surgeries were significantly shorter in the electrocautery group than in the nonelectrocautery group (20.06 ± 2.29 vs. 51.83 ± 12.76 min, p < 0.001). Furthermore, there was no significant difference in seizure control between the two groups (p > 0.05). In two patients, a decline in seizure control classification was noted. However, this did not reach statistical significance. No lead damage or major complications developed in either group.</p><p><strong>Conclusion: </strong>Monopolar electrocautery significantly reduces the operative time during VNS generator revisions without compromising seizure control or increasing the risk of complications. Thus, monopolar electrocautery can be safely used in VNS revision surgeries, potentially streamlining the procedure and improving patient outcomes. However, further studies with larger populations are needed to confirm these findings.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500674"},"PeriodicalIF":0.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of the magnitude and orientation of forces on the odontoid fracture: A finite element model analyses.","authors":"Pedro Miguel González-Vargas, Jorge Caramés, Antonio Riveiro, José Luis Thenier-Villa, Cesáreo Conde, Juan Pou","doi":"10.1016/j.neucie.2025.500675","DOIUrl":"10.1016/j.neucie.2025.500675","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the odontoid, prevalent among the elderly but affecting diverse demographics, pose significant risks ranging from mild discomfort to severe disability or fatality. These fractures, often stemming from trauma, are particularly frequent in the cervical spine. While commonly attributed to high-impact events like traffic accidents in adults, even low-energy incidents such as falls can precipitate these fractures in the elderly. Previous studies have explored loading conditions and treatment effects; however, a comprehensive investigation into the influence of the magnitude and direction of the force involved in the trauma, and the influence of the sex and age of the patient remains scarce so we want to delve deeper into this topic.</p><p><strong>Methods: </strong>This study uses a finite element (FE) model to analyze the response of 3D models of the second cervical vertebra (extracted from computed tomography images) exposed to different loads of magnitude and force. 52 patients were analyzed in this study. The patients were divided into 4 groups: male <70, female <70, male >70, female >70) under different force conditions. Von Mises stress values were obtained when loads of 200 N and 1500 N were applied to the anterior surface of the odontoid with different angles of incidence in the sagittal and axial plane.</p><p><strong>Results: </strong>Odontoid fractures in subjects over 70 years of age are more frequent in female, the maximum stresses produced in the odontoid are 181 MPa and are considerably higher compared to male, which is 131 MPa. In young subjects (<70 years), the differences between sex are less marked, 113 MPa for female and 114 MPa for male.</p><p><strong>Conclusions: </strong>Load direction is one of the main factors affecting odontoid fracture, especially in subjects >70 years of age; by understanding this, the mechanisms that cause different types of fractures can be understood and better strategies can be proposed to apply different treatment approaches to them, both from a medical and surgical point of view.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500675"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}