Neurocirugia (English Edition)最新文献

{"title":"Artificial intelligence in neurosurgery: From technical metrics to deployable clinical evidence.","authors":"Fritz Fidel Váscones-Román, Gonzalo Jair Callahuanca-Flores, Johnny Alejandro Mendoza-Riega, Adrian Elioth Mendoza Perez","doi":"10.1016/j.neucie.2026.500793","DOIUrl":"10.1016/j.neucie.2026.500793","url":null,"abstract":"","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500793"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563943","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":"Neurovascular rarity should not exempt authors from reporting the antithrombotic strategy in detail.","authors":"Patrick Fabrizio Gonzales Romero, Fritz Fidel Váscones-Román","doi":"10.1016/j.neucie.2026.500794","DOIUrl":"10.1016/j.neucie.2026.500794","url":null,"abstract":"","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":" ","pages":"500794"},"PeriodicalIF":0.0,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148564096","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":"Hyponatremia in aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis on management approaches","authors":"Mahdi Mehmandoost,&nbsp;Amirmohammed Bahri,&nbsp;Diba Akbarzadeh,&nbsp;Amirmohammed Tohidnia,&nbsp;Hamidreza Hassanzadeh,&nbsp;Muhammad Paras Pashazadeh,&nbsp;Mohammadreza Moshref,&nbsp;Morteza Sheikhi Nooshabadi,&nbsp;Sayeh Oveisi,&nbsp;Mohammadamin Sabbagh Alvani,&nbsp;Alireza Zali,&nbsp;Saeed Oraee-Yazdani,&nbsp;Farzan Fahim","doi":"10.1016/j.neucie.2026.500775","DOIUrl":"10.1016/j.neucie.2026.500775","url":null,"abstract":"<div><div>Hyponatremia complicates between 32% and 48.9% of aneurysmal subarachnoid hemorrhage (SAH) cases, doubling the risk of cerebral ischemia (24% vs. 12%; <em>p</em> <!-->=<!--> <!-->0.045) and increasing mortality 2.7-fold. However, only 28% of hospitals use standardized protocols, that it highlights the need for evidence-based management. This PRISMA-compliant systematic review and meta-analysis included 21 studies (1749 patients; 1984–2025) from PubMed, EMBASE, and Scopus. The secondary variables analyzed included sodium correction, protocol adherence, delayed cerebral ischemia (DCI) and ICU length of stay. Three main findings were identified: albumin–fludrocortisone synergy: early combination (&lt;72<!--> <!-->h post-SAH) of albumin (60<!--> <!-->g/day) and fludrocortisone reduced hyponatremia by 45% (49.2% to 27.0%) and DCI by 29% (adjusted RR<!--> <!-->=<!--> <!-->0.63). This approach yielded an NNT of 4.3 compared to 13 for clot retrieval. Time-Phased Protocol: Phase I (days 1–3): Albumin<!--> <!-->+<!--> <!-->fludrocortisone decreased symptomatic vasospasm by 67% (<em>p</em> <!-->=<!--> <!-->0.02). Phase II (days 4–7): tolvaptan 15<!--> <!-->mg/day shortened ICU stay by 3.2 days (<em>p</em> <!-->=<!--> <!-->0.01) and improved 6-month mRS scores by 41.7% (<em>p</em> <!-->=<!--> <!-->0.045). Impact of center volume: high-volume centers (&gt;50 SAH cases/year) had 2.1 times higher protocol adherence (89% vs. 23%) and 35% fewer reoperations. The meta-analysis confirmed a significant reduction in symptomatic vasospasm (pooled OR<!--> <!-->=<!--> <!-->0.40; 95% CI: 0.18–0.90; <em>p</em> <!-->=<!--> <!-->0.026) and a higher likelihood of hyponatremia correction (OR<!--> <!-->=<!--> <!-->3.37; 95% CI: 1.57–7.27; <em>p</em> <!-->=<!--> <!-->0.002) in groups receiving active protocols (e.g., albumin/fludrocortisone, tolvaptan) compared to standard care or historical controls. Fluid restriction was associated with higher mortality and is discouraged. A bimodal protocol combining early albumin and fludrocortisone followed by later tolvaptan can lead to better clinical outcomes. Greater institutional experience and real-time sodium monitoring are recommended. Phase III trials comparing saline-based strategies vs. albumin-based are needed.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500775"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147277970","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":"Attracting the best: A challenge for the future of neurosurgery in our country","authors":"Ramiro D. Lobato,&nbsp;Alfonso Lagares,&nbsp;Jose Antonio Fernández-Alén","doi":"10.1016/j.neucie.2026.500761","DOIUrl":"10.1016/j.neucie.2026.500761","url":null,"abstract":"","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500761"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494759","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":"Occurrence of postoperative pneumoencephalus in posterior fossa surgery using the semi-sitting position: Prevalence, factors and patterns","authors":"Liezel Ulloque-Caamaño,&nbsp;Mario Gomar-Alba,&nbsp;Benjamin Romero-Leguina,&nbsp;Nadin J. Abdala-Vargas,&nbsp;Juan F. Villalonga,&nbsp;Álvaro Campero","doi":"10.1016/j.neucie.2026.500763","DOIUrl":"10.1016/j.neucie.2026.500763","url":null,"abstract":"<div><h3>Background</h3><div>Posterior fossa (PF) surgery in the semi-sitting position (SSP) offers benefits for the patient, the anesthesiologist and the surgeon. However, in neurosurgery, neuroanesthesiology and related fields, a certain paradigm has been established regarding the potential high risk of this position, including the possibility of developing postoperative pneumoencephalus (PPN). The objective of the present work is to assess the prevalence, factors, and patterns related with PPN in SSP in a heterogeneous group of patients with PF conditions.</div></div><div><h3>Methods</h3><div>Observational, descriptive, cross-sectional study with prospective data collection. Was conducted in two institutions. January 2020 and June 2023. 192 patients with intradural PF pathology operated on in the SSP were included.</div></div><div><h3>Results</h3><div>In most patients (93.2%; <em>n</em>:179) PPN was observed on postoperative CT. The most frequent pattern of PPN was subdural. No patient (0%; <em>n</em>:0) developed tension PPN, so none required surgery. A significant association was found between subdural PPN and operating time. We found a higher presence of PPN in patients with an age range of 40–60 years and in the group of patients<!--> <!-->&gt;<!--> <!-->60 years.</div></div><div><h3>Conclusions</h3><div>The majority of patients in our series presented PPN. The most frequent pattern was subdural. There was an association between operating time and subdural PPN. There was an association between the older patient groups and PPN. No patient presented tension PPN.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500763"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151317","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":"Research of the effects of myelin basic protein (MBP) and ischemia modified albumin (IMA) levels in blood and cerebrospinal fluid on vasospasm, clinical progress and outcome in patients with non-traumatic subarachnoid hemorrhage","authors":"Adil Ugur Yavuz,&nbsp;Ali Rıza Guvercin,&nbsp;Ali Samet Topsakal,&nbsp;Eda Altunbag Yavuz,&nbsp;Suleyman Caner Karahan,&nbsp;Erhan Arslan","doi":"10.1016/j.neucie.2026.500776","DOIUrl":"10.1016/j.neucie.2026.500776","url":null,"abstract":"<div><h3>Background</h3><div>Non-traumatic subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality, mainly due to secondary brain injury mechanisms such as cerebral vasospasm and delayed cerebral ischemia. Reliable biochemical biomarkers for monitoring disease progression and early outcome assessment remain limited.</div></div><div><h3>Objective</h3><div>To investigate temporal changes in serum and cerebrospinal fluid (CSF) levels of myelin basic protein (MBP) and ischemia-modified albumin (IMA) in patients with non-traumatic SAH and to evaluate their associations with clinical severity and functional outcome.</div></div><div><h3>Methods</h3><div>In this prospective single-center study, 20 patients with non-traumatic SAH were included. Serum and CSF MBP and IMA levels were measured on days 1, 5, and 10 after admission. Clinical severity was assessed using the Modified Fisher scale, Glasgow Coma Scale (GCS), Hunt–Hess scale (HHS), and World Federation of Neurosurgical Societies (WFNS) scale. Functional outcome was evaluated at discharge using the Glasgow Outcome Scale (GOS). Temporal changes and correlations between biomarkers and clinical parameters were analyzed.</div></div><div><h3>Results</h3><div>Serum and CSF MBP levels increased significantly over time (<em>p</em> <!-->&lt;<!--> <!-->0.001), reflecting progressive tissue injury, but showed no consistent association with clinical scores or functional outcome. Serum IMA levels remained elevated without significant temporal variation. In contrast, CSF IMA levels demonstrated a late-phase increase and were significantly associated with clinical deterioration. On day 10, CSF IMA levels correlated negatively with GCS and GOS scores and positively with WFNS scores.</div></div><div><h3>Conclusion</h3><div>MBP reflects cumulative brain injury following SAH, whereas CSF IMA is more closely associated with late-phase neurological deterioration and early functional outcome. CSF IMA may represent a complementary biomarker for prognostic assessment in non-traumatic SAH.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500776"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone flap fixation with clamp-like devices or with titanium plates and screws: A cost-minimization analysis","authors":"Álvaro Gómez de la Riva,&nbsp;Fernando Muñoz-Hernández","doi":"10.1016/j.neucie.2026.500764","DOIUrl":"10.1016/j.neucie.2026.500764","url":null,"abstract":"<div><h3>Objectives</h3><div>Clamp-like devices such as Cranial LOOP have similar performance and safety than titanium plates and screws to fix the bone flap after a craniotomy. This raises the question of which of these methods is more cost-effective. This cost-minimization analysis compares the cost associated with each of these methods in the setting of an already published RCT.</div></div><div><h3>Material and methods</h3><div>The data from a previously published RCT was analyzed to assess the mean cost of bone flap fixation after craniotomy using Cranial LOOP or plates and screws; this analysis included the cost of the devices, the implantation time cost and the implantation instruments reprocessing cost. This data was then analyzed to model the global cost of the craniotomy fixation for a range of implant unitary costs.</div></div><div><h3>Results</h3><div>As a median, craniotomies were fixed with 3 Cranial LOOP or with 4 sets of titanium plates and screws. Both the total and the unitary cost for the devices were significantly lower with Cranial LOOP than with plating systems (306.4<!--> <!-->±<!--> <!-->100.0€ vs 568.8<!--> <!-->±<!--> <!-->261.6€, <em>p</em> <!-->&lt;<!--> <!-->0.001; 88.2<!--> <!-->±<!--> <!-->7.3€ vs 154.9<!--> <!-->±<!--> <!-->67.6€, <em>p</em> <!-->&lt;<!--> <!-->0.001). The implantation time of Cranial LOOP was significantly shorter than that of plating systems (1.70<!--> <!-->±<!--> <!-->0.20<!--> <!-->min vs 6.27<!--> <!-->±<!--> <!-->1.88<!--> <!-->min, <em>p</em> <!-->&lt;<!--> <!-->0.001). Cranial LOOP does not require implantation instruments, while the implantation kits for plating systems require reprocessing (washing and sterilization). In total, the craniotomy fixation with Cranial LOOP costs between 360.56€ and 370.77€ less than with plating systems.</div></div><div><h3>Conclusions</h3><div>The cost of craniotomy fixation with Cranial LOOP was half the cost of fixation with plating systems. In addition, not requiring instrument reprocessing for Cranial LOOP saved water and energy.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500764"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146168265","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":"Complex sacral fractures: Surgical complications and long-term clinical outcomes in a series of patients","authors":"Luis Miguel Moreno-Gómez,&nbsp;Alfonso Lagares,&nbsp;Juan Delgado-Fernández,&nbsp;Francisco Javier Ortega-García,&nbsp;Pedro Caba-Doussoux,&nbsp;Igor Paredes","doi":"10.1016/j.neucie.2026.500777","DOIUrl":"10.1016/j.neucie.2026.500777","url":null,"abstract":"<div><h3>Background</h3><div>Complex sacral fractures with spinopelvic dissociation are rare high-energy injuries in polytrauma patients, and evidence on surgical complications and long-term health-related quality of life (HRQoL) remains limited.</div></div><div><h3>Objectives</h3><div>To describe surgical complications and long-term clinical, radiological, and HRQoL outcomes after spinopelvic fixation, and to analyze associations between pain/disability and clinical or radiological variables.</div></div><div><h3>Methods</h3><div>An ambispective single-center cohort (2012–2022) of patients with complex sacral fractures treated with spinopelvic fixation and ≥12 months of follow-up was evaluated. Clinical, radiological, and HRQoL data were collected, and bivariate correlations were performed with spinopelvic parameters and clinical variables.</div></div><div><h3>Results</h3><div>Twenty-eight patients (13 males, 15 females; mean age 35 years) were included. Six sustained high-speed accidents and the remaining suffered falls. According to the AO classification, 16 fractures were type C and 12 type B. Fourteen patients presented neurological deficits at admission. Postoperatively, seven patients developed deep wound infections, and two experienced new neurological deficits. At long-term follow-up, more than 60% reported persistent pain and gait disturbances. Ten patients showed neurological improvement, whereas eleven had permanent deficits. Spinopelvic parameters demonstrated overall moderate postoperative deformity, with no correlation to long-term clinical outcomes. Age correlated with Oswestry Disability Index (ODI) and Visual Analogue Scale (EVA) scores (all <em>p</em> <!-->&lt;<!--> <!-->0.05). ODI scores were also associated with Intensive Care Unit (ICU) length of stay and neurological deficits (all <em>p</em> <!-->&lt;<!--> <!-->0.05).</div></div><div><h3>Conclusions</h3><div>Spinopelvic fixation was associated with frequent postoperative complications – primarily deep infections and new neurological deficits – and with sustained HRQoL impairment driven by pain, mobility limitation, and reduced physical functioning. Radiological spinopelvic parameters were not related to pain or disability, while older age, prolonged ICU stay, and residual neurological deficits were associated with poorer outcomes. These findings highlight the need for improved infection prevention, neurological protection, and long-term multidisciplinary follow-up.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500777"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147273374","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":"Neurosurgical training in Africa. Part 2: Challenges and solutions for equitable access to neurosurgery","authors":"Ruben Rodríguez-Mena,&nbsp;José Piquer-Martínez,&nbsp;Maria Jose García-Rubio,&nbsp;José Luis Llácer-Ortega,&nbsp;Mubashir Qureshi Mahmood,&nbsp;Jose Piquer-Belloch","doi":"10.1016/j.neucie.2026.500754","DOIUrl":"10.1016/j.neucie.2026.500754","url":null,"abstract":"<div><h3>Background and objective</h3><div>Equitable access to neurosurgery remains a critical challenge in East Africa, due to the shortage of specialists and the lack of structured training programmes. In this second part, the “Equip, Treat, and Educate” (ETE) model, developed by the NED Foundation, is analysed to promote sustainable neurosurgical training in resource-limited settings, in collaboration with COSECSA. A series of innovative initiatives with educational and social impact are also presented.</div></div><div><h3>Materials and methods</h3><div>A retrospective review of the NED Foundation's activities between 2008 and 2024 was conducted, with special emphasis on actions carried out at the NED Institute in Zanzibar. The analysis included clinical data, training programmes, institutional cooperation, and outcomes associated with the ETE model, which is structured into three levels of increasing complexity.</div></div><div><h3>Results</h3><div>During the analysed period, the NED Institute attended to more than 30,000 patients and performed 2537 free surgeries, with hydrocephalus being the most frequently treated condition. In parallel, more than 30 medical and nursing training courses were organised. In addition, thirteen key educational initiatives are proposed to strengthen local capacities, including practical workshops, surgical simulations, mentorship, rotational placements, international exchanges, scholarships, online training, and the development of open resources. These actions can enhance training quality, promote talent retention, and strengthen professional networks in the region.</div></div><div><h3>Conclusions</h3><div>The ETE model, in conjunction with the educational initiatives promoted by the NED Foundation and COSECSA, constitutes an effective and replicable strategy for strengthening neurosurgical training in low-income countries. This approach drives local professional development and enables progress towards more accessible, equitable, and sustainable neurosurgery.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500754"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148341224","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":"Minimally invasive direct screw fixation of Jefferson fractures: A case series and technical note","authors":"Ivan Lvov,&nbsp;Andrey Grin,&nbsp;Anton Kordonskiy,&nbsp;Zaali Barbakadze,&nbsp;Aleksandr Talypov,&nbsp;Aleksandr Tupikin","doi":"10.1016/j.neucie.2026.500766","DOIUrl":"10.1016/j.neucie.2026.500766","url":null,"abstract":"<div><h3>Objective</h3><div>To demonstrate the feasibility of a minimally invasive technique for direct C1 screw fixation and to evaluate short- and long-term clinical and radiological outcomes in a case series.</div></div><div><h3>Materials and methods</h3><div>This study included a consecutive series of patients with type II or III fractures of the C1 vertebra according to the Landells classification. The surgical technique is described in detail, along with short- and long-term outcomes. Owing to the absence of comparison groups, only descriptive statistical methods were used.</div></div><div><h3>Results</h3><div>This case series included 8 patients (5 men and 3 women; mean age, 50.8<!--> <!-->±<!--> <!-->20.0 years). All patients were neurologically intact at presentation. Most patients had concomitant transverse atlantal ligament injury or associated unstable spinal trauma. The mean operative time was 216.3<!--> <!-->±<!--> <!-->100.3<!--> <!-->min, and the mean intraoperative blood loss was 125.0<!--> <!-->±<!--> <!-->71.5<!--> <!-->mL. Seven patients were discharged with clinical improvement, whereas 1 patient died on postoperative day 11 due to severe pneumonia and concomitant injury.</div><div>Six patients were available for final assessment. The mean follow-up duration was 39.7<!--> <!-->±<!--> <!-->31.2 months. The mean VAS score was 2.2<!--> <!-->±<!--> <!-->1.1, and the mean NDI score was 6.8<!--> <!-->±<!--> <!-->3.0. Solid fusion was achieved in all patients. No implant-related complications were observed. In five patients, no degenerative changes were detected in the C1-C2 lateral joints, whereas one patient showed grade 2 degenerative changes.</div></div><div><h3>Conclusion</h3><div>Our initial clinical experience suggests that minimally invasive posterior direct C1 screw fixation is a feasible and safe procedure, providing consistently favourable clinical outcomes in this case series. This technique allowed optimal screw trajectories to be achieved without additional tissue trauma or widening of the surgical exposure. Its application enabled preservation of C1-C2 segmental mobility in all patients included in this series.</div></div>","PeriodicalId":74273,"journal":{"name":"Neurocirugia (English Edition)","volume":"37 4","pages":"Article 500766"},"PeriodicalIF":0.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494728","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}