Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent and surgically treatable condition in the elderly. Ventriculoperitoneal (VP) shunting is the standard treatment, yet outcomes may vary depending on surgical expertise and care delivery models. This study evaluates outcomes of a care bundle strategy for iNPH at a private healthcare provider under public contract. We performed a retrospective analysis of a prospectively collected cohort of consecutive patients undergoing VP shunt placement for iNPH at a private hospital between November 2024 and November 2025. All procedures were performed by two senior consultant neurosurgeons adhering to a care bundle strategy. Clinical outcomes and patient-reported experience measures (PREM) were assessed at one month postoperatively. Eighty patients were included, with 100
Surgical management of mechanically driven neck pain without radiculopathy or myelopathy is a controversial topic, where comparative evidence to non-operative care is limited. This registry-based descriptive cohort study, without a nonoperative comparator, aimed to evaluate longitudinal outcomes after anterior cervical discectomy and fusion (ACDF) for mechanically driven pain presumed to derive from a dysfunctional cervical segment. This observational cohort included all patients identified in Swespine (2006–2024) who underwent ACDF for presumed segmental dysfunctional-related neck pain and had an available baseline NRS neck pain value, and at least one postoperative NRS neck pain follow-up value. Outcome measures included NRS neck pain, Neck Disability index (NDI), health-related quality-of-life index (EQ5D), and postoperative satisfaction. PROMs were observed at 1, 2, 5, and 10 years postoperatively. Clinically meaningful improvements were defined through established MCID thresholds: ≥ 40
Realistic body donor anatomical simulation of intraventricular neuroendoscopy remains limited because ventricular collapse following cerebrospinal fluid loss prevents preservation of physiological ventricular anatomy. We developed a continuous fluid-filled body donor anatomical model to recreate a realistic intraventricular environment for anatomical research, neuroendoscopic simulation, and surgical training. As a separate but complementary objective, the model was used to demonstrate the feasibility of a novel endoscope-controlled bimanual intraventricular approach transitioning from initial fluid-filled ventricular exploration to dry-field surgery. Five fresh body donor anatomical heads were prepared using a gravity-driven ventricular filling system through a frontal external ventricular catheter. A fully endoscopic transcortical approach was performed using exclusive endoscopic visualization and bimanual microsurgical dissection through a mini-corticectomy. Anatomical exposure, surgical manoeuvrability, and model feasibility were qualitatively assessed. Continuous gravity-driven infusion consistently restored and maintained ventricular distension, preserving ventricular anatomy throughout the procedures. Successful ventricular cannulation was achieved in all five specimens, with procedural completion in three. High-quality visualization of the lateral and third ventricles enabled detailed identification of the principal intraventricular landmarks. The proposed approach allowed unrestricted bimanual instrument manipulation through a single surgical corridor under continuous endoscopic visualization and without the need for static retractors. The proposed fluid-filled fresh body donor anatomical model provides a realistic and reproducible platform for neuroendoscopic anatomical research, surgical simulation, and training. It preserves ventricular anatomy, enables high-quality endoscopic documentation, and facilitates the evaluation of novel intraventricular techniques. Within this environment, the proposed minimally invasive endoscopic approach proved feasible and reproducible while preserving unrestricted bimanual microsurgical manipulation.
Outcome after aneurysmal subarachnoid hemorrhage (aSAH) is often devastating with life time issues also for independent survivors. We aimed to identify health related quality of life (HRQoL) issues in this favorable functional outcome group compared to a sex and age matched general population. We have analyzed data from 634 Swedish aSAH patients from a national prospective study ranging between 2014 and 2018. One year after ictus, functional outcome was analyzed using Glasgow Outcome Scale Extended (GOSE) and HRQoL assessed by Euro-quality of life—5 dimensions—3 levels (EQ-5D-3L). Favorable GOSE (5–8) were found in 471 patients. Age- and sex-matched populations were created by published data from a cross-sectional cohort of 32,597 people living in Stockholm County in 2006. Odds ratios (ORs) for rating a specific EQ-5D-3L level were calculated for each domain. Significance was set at α = 0.001. Patients reported less mobility problems than the matched general population (9.6
Dural arteriovenous fistulas (DAVFs) at the C1 level are rare, and conventional microsurgical treatment requires extensive bone resection. We hypothesized that C1 DAVFs supplied exclusively by dural branches of the vertebral artery (VA)—without intradural feeders—could be obliterated via a unilateral partial C1 hemilaminectomy. We retrospectively analyzed patients surgically treated for C1 DAVFs (January 2019–December 2024). Inclusion criteria required symptomatic fistulas supplied exclusively by dural VA branches, without ascending pharyngeal supply or an intradural feeder, on preoperative digital subtraction angiography (DSA). Via a partial C1 hemilaminectomy, the arterialized draining vein was exposed and obliterated. Three of five patients met the inclusion criteria (mean age, 61.3 years); all had Cognard type V fistulas. Presentations included subarachnoid hemorrhage (n = 1) and myelopathy due to venous hypertension (n = 2). In all cases, the hemilaminectomy provided sufficient exposure to identify, coagulate, and divide the fistulous connection. Postoperative DSA confirmed complete obliteration in all patients. One patient had transient occipital hypoesthesia that resolved within three months; there was no permanent morbidity. At one year, motor deficits and cord signal changes had fully resolved in both myelopathic patients, but neurogenic bladder improved only partially in one and persisted in the other; no recurrence was observed. When ascending pharyngeal supply and intradural feeders are absent on preoperative angiography, a unilateral partial C1 hemilaminectomy can achieve complete obliteration without conventional extensive bone resection.
