Surgical neurology international最新文献

{"title":"Endoscopic microvascular decompression for hemifacial spasm associated with an enlarged jugular tubercle: A case report.","authors":"Kassim Muhammad Jabir, Fuminari Komatsu, Yoko Kato","doi":"10.25259/SNI_87_2026","DOIUrl":"https://doi.org/10.25259/SNI_87_2026","url":null,"abstract":"<p><strong>Background: </strong>Hemifacial spasm (HFS) is a clinical syndrome associated with motor dysfunction of the facial nerve as a result of conflict with surrounding vessels. Narrowing of the cerebellopontine angle (CPA) cistern by the abnormality of its bony boundaries has been postulated to increase the risk of such neurovascular conflict (NVC).</p><p><strong>Case description: </strong>We present a case of a 61-year-old man with clinical features of a right-sided HFS of 1-year duration. Brain magnetic resonance imaging and computed tomography angiography with 3D fusion images revealed compression of the right CNVII by a loop of the anterior inferior cerebellar artery at the root entry zone. There was also a finding of an enlarged jugular tubercle causing narrowing of the cerebellopontine cistern, which we postulated to be the underlying cause of the NVC. He had endoscopic keyhole microvascular decompression with resolution of symptoms.</p><p><strong>Conclusion: </strong>Bony enlargement of the jugular tubercle or other bony structures in the CPA could narrow the cerebellopontine cistern and bring the nerve and blood vessels into closer proximity, potentially increasing the incidence of NVC.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"177"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641106","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":"Preoperative embolization in intracranial meningioma surgery: An updated systematic review and meta-analysis.","authors":"Izaz Riaz, Fabio Grassia, Halah Khadija Shah, Muhammad Aftab Hassan, Ceemal Fareed Khan, Dur E Sameen, Saad Akhtar Khan, Mohammad Aadil Qamar, Abdul Basit, Muhammad Riaz","doi":"10.25259/SNI_1367_2025","DOIUrl":"https://doi.org/10.25259/SNI_1367_2025","url":null,"abstract":"<p><strong>Background: </strong>Intracranial meningiomas are vascular tumors often causing significant intraoperative blood loss. Preoperative embolization (POE) aims to reduce vascularity and improve outcomes, though its efficacy is debated. This systematic review and meta-analysis evaluate the impact of POE on operative and postoperative outcomes in intracranial meningioma surgery.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a literature search from 2017 to 2025 identified 13 English-language, non-randomized studies comparing POE to no embolization. Outcomes included intraoperative blood loss, operative time, extent of resection, complications, and tumor recurrence. Due to heterogeneity, a meta-analysis was performed where possible, supplemented by a narrative synthesis. Risk of bias assessment was performed.</p><p><strong>Results: </strong>Meta-analysis revealed that POE significantly reduced complications (odds ratio [OR] 0.68, 95% confidence interval [CI] 0.53-0.88) and increased the likelihood of achieving gross total resection (GTR) (pooled OR 0.61, 95% CI 0.46-0.80). In contrast, findings on intraoperative blood loss and operative time were highly inconsistent with extreme heterogeneity. Tumor recurrence data were extremely limited, reported in only on study, precluding synthesis on long-term outcomes. Significant methodological variability was identified.</p><p><strong>Conclusion: </strong>POE consistently improves the likelihood of achieving GTR in intracranial meningiomas. However, its benefits in reducing intraoperative blood loss and operative time remain inconsistent. Neurosurgeons should consider POE when maximal resection is the primary surgical goal, especially for highly vascular tumors. Future research requires robust designs, such as matched-cohort studies or randomized controlled trials, to definitively establish its precise role.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"170"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641165","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":"Neuroprotective potential of asprosin in traumatic brain ınjury: Histopathological and biochemical insights from an experimental rat model.","authors":"Ali Kaplan, Inan Gezgin, Demet Evleksiz, Gülru Esen, Ebru Annac, Adem Dogan","doi":"10.25259/SNI_1049_2025","DOIUrl":"https://doi.org/10.25259/SNI_1049_2025","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) remains a leading cause of morbidity and mortality, yet pharmacological neuroprotection is still an unmet need. Asprosin, a recently identified fasting-induced adipokine, has been implicated in oxidative stress modulation, apoptosis, and metabolic regulation. This study aimed to investigate the neuroprotective role of asprosin in an experimental rat model of TBI.</p><p><strong>Methods: </strong>Thirty-two male Wistar rats were randomized into four groups: Control, Trauma, Trauma+Asprosin, and Asprosin. Moderate head trauma was induced using a validated closed-head injury model. Asprosin (10 µg/kg, intraperitoneal) was administered immediately and 12 h post-trauma. Brain tissues were examined histopathologically (cresyl violet staining) and biochemically for oxidative stress and apoptotic markers, including Glutathione, total oxidant status, superoxide dismutase, Catalase, Malondialdehyde, glutathione peroxidase, nitric oxide, total antioxidant status, asprosin, and caspase-3.</p><p><strong>Results: </strong>Histopathological evaluation revealed pronounced neuronal degeneration, vacuolization, and darkly stained nuclei in the Trauma and Trauma+Asprosin groups, whereas the control and asprosin-only groups preserved normal cortical and hippocampal architecture. Biochemically, no significant differences were observed among groups for oxidative stress parameters; however, caspase-3 levels were significantly higher in the Asprosin group compared to controls (<i>P</i> = 0.02). These findings suggest that while asprosin modulates apoptosis-related pathways, its direct protective effect against trauma-induced neuronal damage remains inconclusive.</p><p><strong>Conclusion: </strong>This study provides the first experimental evidence linking asprosin to TBI. Although asprosin demonstrated potential interactions with oxidative and apoptotic processes, its role as a neuroprotective agent requires further validation with larger cohorts, varied dosing regimens, and molecular analyses.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"171"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641174","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":"Superior eyelid endoscopic transorbital approach for spheno-orbital tumor: First reported case in Brazil.","authors":"Eduardo Varjão Vieira, Márcio César de Mello Brandão, Luciano Espinheira Fonseca, Leonardo Fraga Lima, Thiago de Oliveira Carneiro","doi":"10.25259/SNI_1055_2025","DOIUrl":"https://doi.org/10.25259/SNI_1055_2025","url":null,"abstract":"<p><strong>Background: </strong>Spheno-orbital meningiomas (SOMs) are rare intracranial tumors arising predominantly from the greater wing of the sphenoid and extending through the middle cranial fossa into adjacent neurovascular corridors, including the cavernous sinus, superior orbital fissure, and optic canal. These lesions often cause significant morbidity due to hyperostotic bone proliferation and compression of orbital contents, resulting in proptosis, cranial neuropathies, and visual impairment. We report the first Brazilian case of a spheno-orbital lesion managed through a superior eyelid endoscopic transorbital approach (ETOA).</p><p><strong>Case description: </strong>A 41-year-old woman presented with complete visual loss in the left eye and progressive oculomotor dysfunction. Imaging revealed a large hyperostotic mass invading the orbit, cavernous sinus, and skull base. Orbital decompression and tumor biopsy were performed using ETOA through the upper eyelid crease. The approach provided safe extradural access to the lateral skull base with minimal brain manipulation. Postoperative imaging confirmed adequate decompression, and longitudinal follow-up confirmed a favorable prognosis. Histopathological analysis revealed a World Health Organization Grade I meningothelial meningioma.</p><p><strong>Conclusion: </strong>This case highlights the feasibility and safety of ETOA for orbital decompression and lesion sampling in complex SOMs and represents the first reported use of this technique in a Brazilian public hospital.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"172"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641211","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":"Minimizing complications in lumboperitoneal shunt for normal pressure hydrocephalus: Technical note and case series.","authors":"Patrizia Pisano, Francesco Salomi, Francesco Guerrini, Massimiliano Todisco, Giannantonio Spena","doi":"10.25259/SNI_1314_2025","DOIUrl":"https://doi.org/10.25259/SNI_1314_2025","url":null,"abstract":"<p><strong>Background: </strong>Normal pressure hydrocephalus (NPH) is a complex syndrome that requires diversion of cerebrospinal fluid in an absorbing compartment. Nowadays, lumboperitoneal shunt is widely validated as treatment option. We present a novel surgical technique to minimize post-surgical complications.</p><p><strong>Methods: </strong>All patients treated for a NPH between 2019 and 2024 at our department were analyzed. Pre- and postoperative clinical and surgical data were assessed. A novel technique with curvilinear lumbar skin incision and tight valve fixing to the lumbar muscular fascia was described.</p><p><strong>Results: </strong>One hundred and eight patients were analyzed with a mean age of 76.5 years. Among these, nine patients had overdrainage symptoms that improved with valve pressure opening adjustment while in five patients, a computed tomography scan showed subdural hematoma of which one underwent surgical evacuation. No surgical complications occurred involving proximal catheter failure or valve malfunction. No infections or wound healing problem were reported. All patients presented neurological improvement.</p><p><strong>Conclusion: </strong>To our experience, our technique with curvilinear incision and valve fixing seems safe, effective, and could lower post surgical complications.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"174"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641110","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":"Nationwide trends and outcomes of transsphenoidal pituitary surgery: A 15-year analysis from the public healthcare system.","authors":"Bruno Pellozo Cerqueira, Afonso Dutra-Melo, Bruna Lisboa do Vale, Francisco Vaz-Guimarães, Samuel Tau Zymberg","doi":"10.25259/SNI_1081_2025","DOIUrl":"https://doi.org/10.25259/SNI_1081_2025","url":null,"abstract":"<p><strong>Background: </strong>Transsphenoidal pituitary surgery is the standard approach for sellar lesions worldwide. However, little is known about its epidemiology, outcomes, and economic burden in low- and middle-income countries. We aimed to analyze nationwide trends of transsphenoidal pituitary surgery in Brazil, using 15 years of data from the public healthcare system.</p><p><strong>Methods: </strong>This was a retrospective, population-based study including patients who underwent transsphenoidal pituitary surgery between 2010 and 2024 in Brazil's Unified Health System (SUS), the public health system. Data were from the national hospital database, covering surgical volume, mortality, length of stay (LOS), and costs.</p><p><strong>Results: </strong>A total of 8,934 surgeries were performed nationwide over 15 years. The Southeast region was responsible for 65% of the surgeries. Surgical volume increased significantly in the Midwest. The median LOS was 11.4 ± 1.2 days, with a progressive decline over time. The average SUS reimbursement was US$878 ± 97 per hospitalization, showing a significant upward trend from 2010 to 2024, with similar values across regions. The overall in-hospital mortality rate was 1.4%.</p><p><strong>Conclusion: </strong>This is the first nationwide study in Latin America to evaluate transsphenoidal pituitary surgeries within a public health system. The findings reveal pronounced regional disparities, with surgical care highly concentrated in the Southeast, while access remains limited in the North and Northeast. Despite demonstrating that the procedure is safe, with low and stable mortality rates, the reimbursement provided by the SUS is substantially lower than international costs, even in the context of longer hospital stays.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"173"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641135","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":"Effect of intraoperative events on quality of life in patients following clipping of ruptured anterior circulation aneurysms.","authors":"Adnan Hussain Shahid, Manju Mohanty, Navneet Singla, Anchal Sharma, Sunil Kumar Gupta","doi":"10.25259/SNI_1181_2025","DOIUrl":"https://doi.org/10.25259/SNI_1181_2025","url":null,"abstract":"<p><strong>Background: </strong>A significant subset of patients undergoing clipping for ruptured aneurysmal Subarachnoid Hemorrhage (SAH) continues to have impaired physical and psychological functions impacting the quality of life (QOL). The determinants of QOL are multifactorial. Surgical events such as intraoperative rupture and temporary clipping time are known to affect the Glasgow outcome score. However, the impact of these events on QOL has not been described to date. The aim of the study is to assess the effect of intraoperative events on QOL in the patient with ruptured anterior circulation aneurysms (ACA) clipping.</p><p><strong>Methods: </strong>A total of 94 patients were recruited into two groups of patients without or with any intraoperative events. QOL was assessed using stroke-specific QOL (SSQOL) and World Health Organization (WHO) QOL-brief assessment instrument (BREF) after 1 year of an event. Intraoperative events were defined as (1) intraoperative rupture during dissection, (2) temporary clipping time of more than 3 min.</p><p><strong>Results: </strong>Both groups were comparable on sociodemographic variables. After 1 year of SAH, both groups were identical on both measures of QOL. However, 48.9% of patients in Group B had poor QOL compared to 38.8% of patients in Group A on SSQOL. The most affected domain was energy. On WHOQOL-BREF, only 13.3% of patients in Group B and 10.2% in Group A had poor QOL. The difference in QOL outcome assessed by two scales was attributed to the difference in the nature of the scales.</p><p><strong>Conclusion: </strong>Although QOL was affected following a-SAH, intraoperative events were not found to be contributing toward the difference in QOL at 1 year.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"175"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641108","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":"Spinal neurosarcoidosis mimicking intramedullary tumors without systemic symptoms: Report of two cases and a systematic review.","authors":"Eliezer Villanueva-Castro, Zachary Porter, Tomas Moncada-Habib, Jacob Taunton, Murat Gokden, Deanna M Sasaki-Adams, Hector Soriano-Baron","doi":"10.25259/SNI_163_2026","DOIUrl":"https://doi.org/10.25259/SNI_163_2026","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary spinal neurosarcoidosis is a rare manifestation of sarcoidosis that can mimic intramedullary spinal cord tumors, especially in the absence of systemic symptoms. Its diagnosis is challenging, and management requires a multidisciplinary approach.</p><p><strong>Case description: </strong>We report two previously healthy male patients presenting with progressive myelopathy due to tumor-like intramedullary lesions. In both cases, limited decompression and diagnostic biopsy revealed noncaseating granulomas consistent with neurosarcoidosis. Postoperative corticosteroid therapy resulted in significant and sustained neurological recovery. One patient required reoperation for mechanical recompression at the cervicothoracic junction. At the latest follow-up, both patients remained relapse-free. A systematic review of surgically treated, histopathology-confirmed intramedullary spinal sarcoidosis cases (<i>n</i> = 15) identified the cervical and cervicothoracic regions as the most common locations. Diagnostic laminectomy was the predominant surgical approach, with gross total resection being rare. Most patients improved neurologically after corticosteroid therapy, although relapses occasionally occurred.</p><p><strong>Conclusion: </strong>Intramedullary neurosarcoidosis may closely resemble spinal cord tumors in imaging and clinical presentation. Early suspicion, integration of magnetic resonance imaging and cerebrospinal fluid findings, and a conservative surgical approach followed by immunosuppressive therapy can improve outcomes and avoid unnecessary aggressive resections.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"180"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641185","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":"Clinical, oncological, and seizure outcomes following surgery for hippocampal gliomas: A systematic review and meta-analysis.","authors":"Ali Hassan Baker, Anjam Ibrahim Rowandizy, Nooruldeen H Ali Al-Khafaji","doi":"10.25259/SNI_147_2026","DOIUrl":"https://doi.org/10.25259/SNI_147_2026","url":null,"abstract":"<p><strong>Background: </strong>Hippocampal gliomas are uncommon tumors located in the temporal lobe, frequently associated with seizures and presenting surgical challenges in proximity to limbic and cognitive regions. The evidence predominantly derives from various retrospective studies, with limited focused analyses on presentation, treatment, and outcomes.</p><p><strong>Methods: </strong>A systematic review and meta-analysis adhered to preferred reporting items for Systematic Reviews and Meta-Analyses guidelines to evaluate outcomes following hippocampal glioma surgery. Studies reporting postoperative results were identified through comprehensive database searches. Pooled proportions for improvement, stability, deterioration, recurrence, mortality, and seizures were estimated using random-effects models. Subgroup analyses examined tumor grade, location, surgical technique, and seizure classification. Bias assessment was conducted utilizing ROBINS-I and Joanna Briggs tools for small case series.</p><p><strong>Results: </strong>Fourteen studies comprising 639 patients were included. Pooled postoperative clinical improvement occurred in 58.7% (95% confidence interval 41.3-76.0) of low-grade and 32.7% (11.9-53.5) of high-grade tumors, while clinical worsening remained uncommon (≤ 4.0% across grades). Mesial temporal tumors demonstrated higher improvement rates than nonmesial tumors (85.0% vs. 68.4%). Favorable seizure outcomes (Engel I-II) were achieved in 77.9% (46.3-109.0), with seizure worsening in < 1%. Recurrence and mortality rates were low overall, with a pooled recurrence of 0.15% and mortality of 0.35% in low-grade tumors, compared with 4.1-7.3% in high-grade tumors, respectively.</p><p><strong>Conclusion: </strong>This meta-analysis reviews outcomes after hippocampal glioma surgery, highlighting common postoperative improvements and seizure control, as well as variability and study limitations. It stresses the need for standardized, prospective research to better understand this rare tumor group.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"178"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641112","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":"Comparison of the lateral extracavitary and lateral thoracotomy surgical approaches for the treatment of thoracic spinal schwannomas.","authors":"Gervith Reyes Soto, Carlos Castillo-Rangel, Mónica Serrano-Murillo, Daniel Alejandro Vega-Moreno, Bosco Emanuel Lazo Poveda, Harvey Misael Aguilar Mora, Manuel de Jesús Encarnación-Ramirez, Juan Carlos García Aquino, Marcos Joaquin Robles Ortiz, Moisés Jacob López-Juárez, José Humberto Ayala-Gómez","doi":"10.25259/SNI_963_2025","DOIUrl":"https://doi.org/10.25259/SNI_963_2025","url":null,"abstract":"<p><strong>Background: </strong>Thoracic spinal schwannomas are benign nervesheath tumors that can cause significant neurological impairment. Surgical resection remains the treatment of choice and gold standard for achieving gross total resection and preventing recurrence. The lateral extracavitary approach (LECA) and lateral thoracotomy (LT) are commonly used techniques; however, the relative advantages of these two approaches remain uncertain, and comparative data in the Mexican population are lacking.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of adults undergoing LECA or LT for thoracic spinal schwannoma at the National Cancer Institute of Mexico (2011-2018). Patients were selected according to tumor location, extension, cardiopulmonary tolerance, and surgeon experience, as detailed in the study methods. Demographic, radiological, and perioperative data were collected. Outcomes included tumor size/volume, operative time, estimated blood loss (EBL), length of stay (LOS), pain (Visual Analog Scale, VAS), neurological outcome (American Spinal Injury Association grade), and complications. Statistical significance was set at <i>P</i> < 0.05. Given the observed differences in tumor volume between groups, a dedicated statistical comparison was performed using the Mann-Whitney U test. In addition, a stratified analysis by tumor size (≤50 cm³ vs. >50 cm³) was conducted to evaluate whether differences between surgical approaches persisted within each stratum.</p><p><strong>Results: </strong>Forty-three patients were included (LECA <i>n</i> = 23; LT <i>n</i> = 20). Median EBL was lower with LECA (180 mL) versus LT (600 mL; <i>P</i> = 0.019). LECA had shorter operative time (median 3 h vs. 5 h; <i>P</i> < 0.001) and hospital stay (4 vs. 11 days; <i>P</i> = 0.004). Pain improved significantly after LECA (VAS 8→2; <i>P</i> < 0.001) but not after LT (9→7; <i>P</i> = 0.70). Tumor volume was significantly larger in the LT group (<i>P</i> < 0.0001), representing a potential confounder; however, the advantages of LECA persisted in the stratified analysis (≤50 cm³ and >50 cm³). Complications occurred in 10% (LECA) versus 25% (LT), not statistically significant given the small cohort. No perioperative mortality occurred.</p><p><strong>Conclusion: </strong>In this single-center retrospective cohort, LECA was associated with reduced operative time, blood loss, LOS, and postoperative pain compared with LT. The potential benefits of LECA likely reflect improved exposure and reduced pleural morbidity inherent to the approach, though confounding by tumor size and patient selection cannot be excluded. Given the retrospective design and limited statistical power, findings should be interpreted cautiously and validated in prospective multicenter studies.</p>","PeriodicalId":94217,"journal":{"name":"Surgical neurology international","volume":"17 ","pages":"183"},"PeriodicalIF":0.0,"publicationDate":"2026-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13054324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147641123","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}