Neurocirugia (English Edition)最新文献

{"title":"Ozone therapy in the treatment of low back pain: A systematic review of its evolution, clinical application, and efficacy.","authors":"Mónica Gabriela Delgado-Caicedo, Ashly Verónica Arias Obando, Juan Carlos Acevedo-González","doi":"10.1016/j.neucie.2026.500796","DOIUrl":"10.1016/j.neucie.2026.500796","url":null,"abstract":"<p><p>Low back pain is a major cause of disability worldwide. Ozone therapy has emerged as a therapeutic alternative; however, its efficacy and safety remain controversial. A systematic review was conducted in accordance with PRISMA guidelines using PubMed, Scopus, Embase, Ovid, EBSCOhost, and Google Scholar (2013-2023). Randomised clinical trials, observational studies, systematic reviews, and meta-analyses were included. Study selection was performed using Rayyan, and methodological quality was assessed with STROBE, CONSORT, and QUADAS.A total of 28 studies were included. Although some reported clinical improvement, methodological heterogeneity, the use of combined therapies, the absence of adequate control groups, and the presence of adverse events predominated. Current evidence is insufficient to support the recommendation of ozone therapy as an effective treatment for low back pain. Further studies with stronger methodological designs, clear diagnostic criteria, and standardised intervention protocols are needed.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500796"},"PeriodicalIF":0.0,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186525","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":"Utility and applications of high-field 1.5 T intraoperative magnetic resonance in pediatric neurosurgical practice after 5 years of experience","authors":"Victoria Becerra Castro,&nbsp;José Hinojosa Mena-Bernal,&nbsp;Diego Culebras Palao,&nbsp;Mariana Alamar Abril,&nbsp;Marta Gómez Chiari,&nbsp;Jordi Muchart López","doi":"10.1016/j.neucie.2026.500783","DOIUrl":"10.1016/j.neucie.2026.500783","url":null,"abstract":"<div><h3>Background and objectives</h3><div>High-field 1.5<!--> <!-->T intraoperative magnetic resonance imaging (iMRI) was installed in our institution in 2020. Since then, it has been routinely used in pediatric neurosurgical practice. The purpose of this study was to describe our experience with this intraoperative imaging modality in a cohort of pediatric patients, focusing on the benefits, risks, and limitations in neurooncological practice and other entities such as the management of hydrocephalus and vascular disease.</div></div><div><h3>Materials and methods</h3><div>From February 2020 to April 2025, a series of consecutive pediatric cases involving various neurosurgical procedures were analyzed to describe the usefulness, safety, and challenges of using iMRI. Patients were categorized into five groups based on the type of surgery. Additional tumor resection after iMRI, early reoperation rate, and complications were analyzed.</div></div><div><h3>Results</h3><div>During this period, a total of 374 surgeries were performed with MRI. Of these, 141 were oncological surgeries; 7 were for vascular pathology; 10 were for hydrocephalus management; and 6 miscellaneous; 188 epilepsy surgeries and 22 functional pathology, which will be detailed in another submission. The mean age was 9.62 years (range: 2 months–18 years). After iMRI, the degree of surgical resection was improved in 11.4% (11/96) of cases of tumor resection surgeries. The early reoperation rate was 0% in the first month. This imaging control adapted postoperative management in 6 patients in whom complications were detected. In 52 of 164 of the patients analyzed (32%), iMRI was used as a final control, saving the patient from a second sedation that would have been necessary for early postoperative iMRI. The mean duration of the intraoperative imaging process was 54<!--> <!-->±<!--> <!-->6<!--> <!-->min, and 3–4<!--> <!-->min for the check list.</div></div><div><h3>Conclusions</h3><div>iMRI in pediatric neurosurgical procedures was a useful, safe, and reliable tool. Its use improved the extension of tumor removal and avoids the need for early reintervention. Limitations were associated with the application of strict safety protocols to prevent accidents in highly complex environments and the inherent challenges associated with positioning pediatric patients due to headrests and non-compatible surgical tables.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 5","pages":"Article 500783"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907730","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 evolution of the Neurosurgery Residency System in North America. Part II: From the 1970s to the present","authors":"Ramiro D. Lobato,&nbsp;Luis Jiménez-Roldán,&nbsp;Igor Paredes,&nbsp;Pablo M. Munarriz,&nbsp;Beatriz Pascual,&nbsp;Andreea Baciu,&nbsp;Alfonso Lagares","doi":"10.1016/j.neucie.2026.500760","DOIUrl":"10.1016/j.neucie.2026.500760","url":null,"abstract":"<div><div>In this second part of the article on the Residency System in North America we analyse the impact of the changes in the management and financing of healthcare on the evolution of training. The restriction of financial resources introduced by the <em>third-party payer</em> system and duty hour regulations ultimately deterioraterd the quality of training and the conduct of research by residents. The potential strategies to sustain and improve the Residency System at the end of the first quarter of the 21st century are commented.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 5","pages":"Article 500760"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494738","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 evolution of the neurosurgery residency system in North America. Part I. From the origins to the 1970s","authors":"Ramiro D. Lobato,&nbsp;Luis Jiménez-Roldán,&nbsp;Ángel Pérez Núñez,&nbsp;Pedro González,&nbsp;Ana María Castaño-León,&nbsp;Mónica Maldonado,&nbsp;Alfonso Lagares","doi":"10.1016/j.neucie.2026.500759","DOIUrl":"10.1016/j.neucie.2026.500759","url":null,"abstract":"<div><div>This article analyzes the evolution of the residency system in the United States of America, from its inception at Johns Hopkins Hospital and Medical School to the 1970s, and is followed by a second paper (Part II) completing the analysis up to the present day. The establishment of a formal residency system began with the altruistic commitment of an academic staff dedicated full-time to clinical care, teaching, and research, along with the equally unconditional dedication of the first residents, who, in exchange for their exhausting work, received only the knowledge they acquired. This initial scenario contrasts sharply with the current situation, in which – despite having excellent technical resources and stable working conditions – the academic hospital staff and residents experience a decline in the quality of teaching and research. A decline caused, among other factors, by funding cuts and the reduction of residents’ working hours, which have forced them to “compress” their workload to the detriment of both patient care and their own learning. A better understanding of the advances and setbacks experienced by the residency system throughout the 20th century and the first two decades of the 21st may help address some of the dysfunctions that currently affect it.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 5","pages":"Article 500759"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494723","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":"Pituitary metastasis from renal cell carcinoma: Case report, systematic review, and worldwide distribution analysis","authors":"Alma R. García-Nájera,&nbsp;Carolina Vásquez-Rafael,&nbsp;Francisco J. Benítez-Rodríguez,&nbsp;Omar García-Nájera,&nbsp;Tania I. Gamboa-Jiménez,&nbsp;Wendy Martínez-Pineda,&nbsp;Josué Vergara-Juárez,&nbsp;Armando Armas-Salazar,&nbsp;José D. Carrillo-Ruiz,&nbsp;Fiacro Jiménez-Ponce,&nbsp;Jesús Q. Beltrán","doi":"10.1016/j.neucie.2025.500740","DOIUrl":"10.1016/j.neucie.2025.500740","url":null,"abstract":"<div><div>Pituitary metastases from renal cell carcinoma (PM-RCC) are rare, with an unfavorable prognosis and survival ranging from 6 to 22 months. The objectives of this study were (1) to present a case of a 61-year-old male who achieved a 44-month survival, and (2) to analyze the literature focusing on survival and worldwide distribution. The reported case achieved one of the longest survivals documented after multimodal treatment including surgery, radiotherapy, and targeted therapy. The systematic review showed that PM-RCC predominantly affects males (73.7%) and has a mean survival of 10.9 months, lower than that reported for other pituitary metastases (median 16.5 months). Metastasis was initially suspected in only 13.1% of cases, and surgery was the most common treatment (84%), with wide variation in adjuvant therapy use. Most cases originated from high-income countries, with very limited or no representation from some regions. Relevant characteristics and prognostic factors are discussed.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 5","pages":"Article 500740"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688776","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":"Brachial plexus tumours: Diagnosis, treatment, surgical approach, and outcomes in a series of 47 patients","authors":"Alberto Isla,&nbsp;Sabela Vázquez,&nbsp;Beatriz Mansilla,&nbsp;María Santiago,&nbsp;Susana Santiago,&nbsp;Pablo Garcia-Feijoo","doi":"10.1016/j.neucie.2026.500755","DOIUrl":"10.1016/j.neucie.2026.500755","url":null,"abstract":"<div><h3>Introduction</h3><div>Brachial plexus tumours are uncommon, with a prevalence of less than 5% of upper extremity tumours, and their surgical resection represents a major challenge due to the anatomical complexity of the region. The aim of this retrospective study is to analyze, in a large patient series, the clinical, radiological, and surgical characteristics of brachial plexus tumours, as well as to evaluate the different surgical approaches used according to tumour location and characteristics.</div></div><div><h3>Material and methods</h3><div>A retrospective study was conducted of all patients operated on for brachial plexus tumours between 2000 and 2025 at a tertiary center. Clinical, radiological, histological, surgical, and follow-up variables were collected. Approaches were classified as supraclavicular, infraclavicular, supra-infraclavicular, and posterior. Mild and severe neurological deficits were defined. Descriptive statistics and <em>χ</em>² tests were used to analyze the relationship between tumour size and malignancy.</div></div><div><h3>Results</h3><div>Forty-seven patients were included (mean age: 48.5 years; 55.3% women). The most common symptom was pain (72.3%). The tumours were: schwannomas 29.8%, neurofibromas 27.7%, malignant 25.5%, metastases 4.3%, and miscellaneous 12.8%. Complete resection was achieved in 53.2%, being more frequent in schwannomas. The most frequent locations were the posterior cord and the inferior trunk. The size-malignancy relationship showed a non-significant trend towards higher malignancy in tumours &gt;50<!--> <!-->mm (<em>p</em> <!-->=<!--> <!-->0.072). After surgery, 46.8% were left without sequelae; new motor deficit was more common in patients without prior deficits. Recurrences were recorded in 23.4% and progression of residual tumour in 14.9%.</div></div><div><h3>Conclusions</h3><div>Surgical resection of brachial plexus tumours depends on histological type, size, and their relationship with neurovascular structures. Schwannomas allowed a higher rate of total resection, unlike neurofibromas and malignant tumours, which were limited by infiltration and size. We highlight the usefulness of surgery for functional improvement, as most patients improved in this aspect, aided by intraoperative neurophysiological monitoring.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 5","pages":"Article 500755"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494745","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":"Clinical and radiological outcomes of ACDF using titanium-screw PEEK cages: A retrospective series","authors":"Francisco Verdú López,&nbsp;Vicente Vanaclocha,&nbsp;Alejandra Hernández-Valido,&nbsp;David Aliaga,&nbsp;José-María Gallego-Sánchez,&nbsp;Ana-María Morales-Codina","doi":"10.1016/j.neucie.2026.500778","DOIUrl":"10.1016/j.neucie.2026.500778","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical and radiological outcomes of anterior cervical discectomy and fusion (ACDF) using titanium-screw PEEK cages, focusing on fusion rates, cervical alignment, pain relief, and complications.</div></div><div><h3>Methods</h3><div>Retrospective observational study of 40 consecutive patients treated between May 2017 and December 2018. Outcomes included Neck Disability Index (NDI), Numerical Rating Scale (NRS) for cervical and radicular pain, and radiological parameters (fusion status, Cobb angles, disk height). Complications were systematically documented, and longitudinal changes were analyzed using the Friedman test for repeated measures.</div></div><div><h3>Results</h3><div>At 2-year follow-up, all patients achieved radiological fusion (Bridwell grades I–II). Median NDI improved from 56% to 20% (<em>p</em> <!-->&lt;<!--> <!-->0.001). Cervical and radicular pain scores decreased significantly (median NRS from 8 to 2 and 7 to 1; <em>p</em> <!-->&lt;<!--> <!-->0.001). Cervical alignment and disk height improved and remained stable. Dysphagia and dysphonia occurred in 5% and 2.5% of cases, respectively, resolving spontaneously.</div></div><div><h3>Conclusions</h3><div>ACDF using titanium-screw PEEK cages is safe and effective, providing high fusion rates, significant clinical improvement, and low complication rates. These zero-profile hybrid devices offer a reliable alternative to traditional cage-plate constructs.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 5","pages":"Article 500778"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273379","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 microsurgery laboratory in neurosurgical training","authors":"Emilio González Martínez,&nbsp;Belén Álvarez Fernández,&nbsp;María Victoria Diago Santamaría,&nbsp;Giancarlo Mattos Piaggio,&nbsp;Javier Robla Costales,&nbsp;Javier Ibáñez Plágaro,&nbsp;José García-Cosamalón","doi":"10.1016/j.neucie.2026.500765","DOIUrl":"10.1016/j.neucie.2026.500765","url":null,"abstract":"<div><div>The complexity of the dissection and nerve, vascular, arachnoid, and dural reconstruction techniques faced by neurosurgeons in their daily practice demands microsurgical training in the laboratory. Vascular microanastomosis techniques are essential for cerebral revascularization, the treatment of complex aneurysms, and the resection of some skull base tumors. However, training in microvascular surgery presents the challenge of being difficult to teach intraoperatively, along with the disadvantage of a limited number of clinical cases due to the rise of endovascular procedures. Microsurgical training should be conducted through a structured and supervised program, using validated models of increasing difficulty. For preliminary exercises, synthetic models and ex-vivo biological tissues are useful. Proficiency is achieved by performing microanastomosis (end-to-end and end-to-side) in living animals. In this article, we describe the most suitable models for training neurosurgery residents in the microsurgery laboratory, based on over three decades of our teaching experience in microsurgery.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 5","pages":"Article 500765"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148842357","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":"Malignant triton tumour of the nerve roots: Challenging the neuropreservation paradigm. Presentation of two cases and review.","authors":"Alicia Godoy Hurtado, Patrick Bärtschi, Adela Sabio Gonzalez, Osamah E L Rubaidi","doi":"10.1016/j.neucie.2026.500792","DOIUrl":"10.1016/j.neucie.2026.500792","url":null,"abstract":"<p><p>Malignant triton tumour constitutes a rare and particularly aggressive subgroup within the so-called malignant peripheral nerve sheath tumours. It belongs to the group of sarcomas and is diagnosed more frequently and aggressively in patients with neurofibromatosis type I, with a peak age of around 30 years. They develop preferentially in medium and large nerves such as cranial nerves, plexuses and nerve roots. The 5-year survival rate is approximately 5-15% according to published series, compared to 34-52% in other malignant tumours of the nerve sheaths. Radical surgery with clear margins followed by radiotherapy for local control appears to offer the best results in terms of survival. We describe two cases treated at our centre and review the scientific literature, highlighting the role of the pathologist and neurosurgeon in their management.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500792"},"PeriodicalIF":0.0,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148671435","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":"Anatomical references beyond the vidian canal in petrous apex endoscopic approaches: A radiologic study and clinical correlations.","authors":"Arnold R Quiroz Tejada, Laila Pérez de San Román Mena, Pablo Miranda Lloret, Juan A Simal-Julian","doi":"10.1016/j.neucie.2026.500795","DOIUrl":"10.1016/j.neucie.2026.500795","url":null,"abstract":"<p><p>The vidian nerve is a well-recognized landmark in endoscopic endonasal skull base surgery, as it helps identify the internal carotid artery at the foramen lacerum and allows surgeons to safely approach the petrous region. However, to the best of the authors' knowledge, there are no clearly defined landmarks when the surgical corridor advances posteriorly and superiorly through the petrous bone, behind the internal carotid artery. This study aimed to provide anatomical and radiological references, based on patient-specific anatomy, for approaching the petrous apex through endoscopic endonasal approaches. Twenty petrous bones from ten patients were analyzed, defining skull base landmarks and their posterior projections, namely the newly named naso-vidian, naso-carotid, and naso-paraclival lines. The distance between these projections and other standard skull base landmarks was measured to establish their anatomical correlations. The posterior projections of the naso-vidian and naso-carotid lines deviated by a mean of 2.5mm and 2.1mm, respectively, when measured against the internal acoustic meatus. In postoperative CT scans of endonasal petrosectomies performed at our center, the average distance from the bone edge reached to the antero-inferior border of the internal acoustic meatus was 1.7mm. The naso-vidian and naso-carotid lines may function as suitable references when approaching the petrous apex, as they commonly project towards the internal acoustic meatus, aiding in preoperative planning for endonasal skull base approaches to this region.</p>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500795"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563930","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}