Impedance values exceeding 10,000 Ω are a recognized indicator of hardware failure in deep brain stimulation (DBS) systems. However, impedance assessment relies exclusively on programmer-mediated telemetry conducted by trained neuromodulation specialists with access to manufacturer-specific equipment. When symptoms worsen or therapeutic benefit declines, a clinically accessible correlate of elevated impedance would facilitate timely evaluation of complications including system malfunction.In this study, we report the reproducible detection of high impedance by auscultating the implanted pulse generator (IPG). Stimulation through high impedance contacts (>10,000 Ω) was consistently distinguishable from normal-impedance contacts, and when the IPG was turned off, using a standard stethoscope, across patients.Spectral analysis of the auscultatory signal was performed for further characterization. Analysis demonstrated discrete, high-amplitude peaks at integer harmonics of the programmed stimulation frequency, consistent with nonlinear transduction within the system. These high amplitude harmonics were absent under normal conditions.These findings demonstrate an association between high impedance and an accessible clinical correlate. While a larger cohort study is needed to validate the clinical utility of this association, this case describes how auscultation with a stethoscope can represent a simple, non-invasive adjunct for detecting hardware failure in an implanted DBS system.
Objective Delayed cerebral ischemia (DCI) is a fatal complication of subarachnoid hemorrhage (SAH) causing high mortality and disability. This study aimed to explore the predictive value of optical coherence tomography angiography (OCTA)-based retinal macular microvascular density for SAH-related cerebral vasospasm and infarction. Methods Sixty enrolled subjects were divided into SAH with cerebral infarction, pure SAH and healthy control groups (20 cases each). Macular superficial and deep capillary plexus densities in four subregions (C1–C4) were analyzed. One-way ANOVA with post-hoc pairwise t-test was used for statistical analysis, and ROC curves were applied to evaluate predictive efficacy. Results The SAH-infarction group showed significantly reduced vascular density in C1 and C2 subregions (p < 0.05), while C3 and C4 density showed no significant changes. C1 and C2 vessel density exhibited good predictive performance, with superficial AUCs of 0.85, 0.743 and deep AUCs of 0.80, 0.69. Conclusion Regional retinal microvascular reduction is characteristic of SAH patients with secondary cerebral infarction. OCTA parameters have promising clinical value for early screening and prognosis assessment of post-SAH DCI.
Background In patients with primary central nervous system lymphoma (PCNSL), surgical intervention is limited to biopsy for pathological diagnosis. Stereotactic tumor biopsy (STB) is widely used due to minimal invasiveness. However, blind sampling carries a hemorrhage risk and may yield insufficient tissue. Endoscopic tumor biopsy (ETB) has emerged to address these limitations, yet its perioperative invasiveness relative to other biopsy techniques remains inadequately characterized. Objective This study aimed to evaluate the perioperative invasiveness and feasibility of ETB compared with STB in patients with PCNSL. Methods We retrospectively reviewed 28 consecutive patients with PCNSL who underwent tumor biopsy: open tumor biopsy (OTB; n = 12), STB (n = 7), and ETB (n = 9). Operative variables, including bone-opening size, operative time, and blood loss, were analyzed along with perioperative inflammatory response measured by C-reactive protein (CRP). Results The three groups did not differ significantly in age, preoperative Karnofsky performance status, tumor size, operative time, or blood loss. Tumors approached via OTB were closer to the brain surface and required significantly larger bone-opening sizes than those approached via STB or ETB. Perioperative CRP elevation was greater in the OTB group. No statistically significant differences in the measured perioperative parameters were detected between the STB and ETB groups. No surgery-related complications occurred in any patient. Conclusions ETB may be a minimally invasive procedure and could be one of the options for biopsy of PCNSL.
Introduction Osteoporotic vertebral compression fractures (OVCFs) can compromise spinal stability, leading not only to functional impairments but also to significant impacts across multiple health domains. This study compares the clinical outcomes and prognostic significance of percutaneous vertebroplasty (PVP) and the SpineJack® (SJ) technique in the stabilization of OVCFs. Objective To determine whether PVP or the SJ technique provides superiority in pain relief in patients with OVCFs. Because an implant designed to restore vertebral height will, on mechanical grounds, correct kyphosis more than a stabilization-only technique, the clinically relevant question addressed here is whether the additional anatomical correction achieved with SJ translates into superior clinical outcomes compared with PVP. Secondary outcomes include improvement in functional outcomes and kyphosis restoration at a six-month follow-up. Materials and methods Prospective, comparative study including thirty-one patients with painful OVCFs (VAS > 5) eligible for both percutaneous vertebral stabilization techniques. Procedures were performed by the Interventional Radiology service at Hospital del Mar. Clinical outcomes were assessed preprocedure and at four hours, one month and six months using the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index (ODI) and local kyphotic angle changes as variables. PVP and SJ outcomes were compared with longitudinal and bivariate analyses. The predefined primary endpoint was the change in VAS score from baseline to six months; all remaining outcomes were secondary. Because treatment allocation was physician-driven and non-randomized, the between-group comparison was predefined as exploratory and hypothesis-generating. Results Both groups showed significant pain (VAS) and disability (ODI) improvement. SJ achieved greater pain relief at one month and significantly higher correction of local kyphotic angle. Complication rates were low and similar between groups. Conclusions SJ provides greater correction of local kyphosis compared with PVP, though both techniques offer significant pain and disability improvement. Six-month pain outcome may depend more on fracture stabilization than on deformity correction. Further multicenter, prospective, randomized trials are needed to confirm potential advantages of SJ in OVCFs.
Background Incidental durotomy is a frequent intraoperative complication in lumbar spine surgery and requires advanced technical skills to prevent adverse outcomes. Despite the importance of surgical proficiency, there is a lack of realistic training models that adequately replicate intraoperative conditions, particularly for dural repair under cerebrospinal fluid (CSF) leakage. Methods Four soft-embalmed human cadavers prepared using the Dodge method were used to simulate incidental durotomy and subsequent dural repair under controlled CSF flow conditions. A board-certified spine surgeon performed all procedures. Realism and training value were assessed using a structured Likert-scale questionnaire, evaluating both general training experience and specific surgical steps. Results The expert rated the training as a realistic and valuable preparation for clinical practice, with high scores for surgical access, tissue characteristics, and handling of the dura mater. Dural incision and suturing under simulated CSF flow were consistently perceived as realistic. The training was considered beneficial for increasing confidence among less experienced surgeons and was strongly recommended in a workshop setting. Conclusions Dura repair on Dodge-embalmed cadavers represents a feasible and realistic training model that closely approximates clinical conditions. This approach may enhance surgical skill acquisition and confidence in managing incidental durotomies. However, the findings are limited by evaluation from a single expert and a small sample size. Further studies involving multiple evaluators and larger cohorts are required to validate these results.
Objectives This study aimed to compare the clinical efficacy of three minimally invasive regimens for patients with osteoporotic vertebral compression fractures (OVCF): percutaneous kyphoplasty (PKP), percutaneous vertebroplasty (PVP), and TCM hyperextension reduction manipulation combined with PVP (TCMHR-PVP). Methods We retrospectively analyzed clinical data from 150 OVCF patients admitted to our hospital between March 2016 and June 2019. Patients were equally divided into three groups (n = 50 per group): Group A (PKP), Group B (PVP), and Group C (TCMHR-PVP). The Visual Analog Scale (VAS) was used to evaluate low back pain intensity, and thoracolumbar spinal range of motion was recorded at preoperative baseline and follow-up timepoints: 24 h, 30 days, 90 days, 180 days, and 1 year. Observation indicators included sagittal Cobb angle kyphosis correction rate, postoperative refracture risk of fractured and adjacent vertebrae, and long-term spinal biomechanical stability. Results No postoperative complications such as deep vein thrombosis and surgical site infection were detected at the 3-month and 6-month follow-ups. All three groups achieved obvious imaging improvement, with Group C showing the optimal effect, followed by Group A and Group B. Intergroup comparison showed statistically significant differences in the sagittal Cobb angle restoration rate of fractured vertebrae among the three groups and between Group B and Group C (both P < 0.05). The VAS pain improvement rate was significantly elevated postoperatively in all groups. Group C obtained superior pain relief and recovery of daily living function compared with Group A (P < 0.05), while no significant difference in VAS was found between preoperative and postoperative data within Group B (P > 0.05). No significant intergroup differences in Oswestry Disability Index (ODI) improvement rates were observed at baseline and early follow-up between Group A and Group C. Significant ODI differences existed among all three groups at the 6-month follow-up (P < 0.05), and differences between Group A and Group C as well as preoperative vs postoperative of Group B remained significant at 1 and 3 months (P < 0.05). Group B had a significantly higher risk of adjacent vertebral refracture (P < 0.05). One-year overall comparison showed no intergroup difference in refracture incidence (P > 0.05). Significant disparities were observed among three groups at 1, 3 and 6 months postoperatively (P < 0.05), but disappeared at the 1-year follow-up (P > 0.05). Conclusions All three surgical interventions can effectively alleviate back pain, reinforce and stabilize fractured vertebrae, restore vertebral height, and correct thoracolumbar kyphotic deformity. Long-term follow-up found that patients receiving simple PVP suffered persistent residual lumbago, and PKP patients presented recurrent low back pain. Both surgeries are accompanied by postoperative vertebral height loss and elevated refracture risk of fractured and adjacent vertebrae. These adverse outcomes break musculoskeletal biomechanical balance, reduce long-term spinal stability, and eventually accelerate thoracolumbar degenerative changes.
Background Superior sagittal sinus (SSS) injury remains one of the most technically demanding challenges in cranial neurosurgery. Management differs fundamentally between emergency traumatic injury, which requires rapid hemorrhage control and preservation of cerebral venous outflow, and elective surgery for sinus-invading tumors, where maximal safe resection must be balanced against maintenance of venous drainage. Although these clinical scenarios have traditionally been investigated separately, both are governed by common principles of cerebral venous physiology. This review synthesizes contemporary evidence comparing emergency and elective SSS injury, with particular emphasis on venous reconstruction, postoperative cerebral venous sinus thrombosis (CVST), neurocritical care, and physiology-guided surgical decision-making. Methods We conducted a systematic review with narrative synthesis incorporating an umbrella-review component, in which two systematic reviews served as anchor evidence sources and were supplemented by eligible contemporary primary studies. PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were searched from database inception to June 2026. Two systematic reviews served as the principal evidence base and were supplemented by contemporary primary studies addressing venous reconstruction, postoperative CVST, neurocritical care, and advances in microsurgical management. Methodological quality was evaluated using the AMSTAR-2 framework, and certainty of evidence was assessed using the GRADE approach. Results Fifty-four eligible publications were included in the qualitative evidence base. Across emergency and elective settings, preservation of functional cerebral venous drainage was consistently associated with lower rates of venous infarction, cerebral edema, postoperative CVST, and neurological morbidity. Emergency SSS injury was supported primarily by retrospective series and case reports, whereas elective SSS surgery was informed by larger institutional cohorts and one systematic review with meta-analysis. Despite differences in clinical presentation and operative objectives, both settings favored individualized, physiology-guided management based on sinus patency, collateral venous circulation, and preservation of cortical bridging veins. The overall certainty of evidence was low because of the predominance of retrospective observational studies and heterogeneous outcome reporting. Conclusion Emergency traumatic injury and elective sinus-invading tumors represent distinct clinical scenarios but share fundamental principles of cerebral venous preservation. The available literature is consistent with an individualized, physiology-guided approach that considers venous preservation, selective reconstruction, postoperative surveillance, and multidisciplinary neurocritical care. Because the underlying evidence is predominantly retrospective, these findings should be interpreted as evidence-informed considerations rather than definitive clinical recommendations.
Introduction Multiple intracranial aneurysms (MIA) occur in 20%–34% of patients with intracranial aneurysms and are associated with worse prognosis than solitary aneurysms. MIA predominantly affects patients aged 40–60 years, with a higher prevalence in females. Patients aged 45–65 years account for 60% of ruptured cases, representing a high-risk population. Most patients present with two aneurysms, and mirror aneurysms constitute approximately 10%. With the widespread application of CT, CTA and DSA, the detection rate of MIA has increased significantly. Management of MIA remains challenging due to variable number and location, and accurate identification of the ruptured aneurysm is critical to avoid unfavorable outcomes. Limited high-quality controlled cohort studies have clarified independent risk modifiers and long-term functional benchmarks for individualized MIA treatment; this single-center retrospective cohort aims to summarize stratified individualized endovascular and surgical strategies, provide real-world angiographic and functional follow-up data, and benchmark clinical outcomes against contemporary literature to supplement evidence for comprehensive MIA management. Methods We retrospectively analyzed 53 patients with MIA treated at our institution between 2019 and 2025. Treatment strategies, including single-stage or staged procedures, endovascular embolization, surgical clipping, or combined therapy, were determined based on CT and DSA findings. Baseline preoperative neurological function (Hunt-Hess, modified Fisher) and post-operative 3/12/36-month GOS functional status were systematically recorded for all patients. All patients were scheduled for clinical surveillance and angiographic follow-up with DSA to evaluate neurological function and aneurysm status. Results The mean follow-up duration was 34.6 ± 15.3 months (range, 6–78 months), with one patient lost to follow-up. Among the 53 patients, 39 underwent embolization alone, 4 embolization combined with clipping, and 7 clipping alone. Thirty-seven patients received single-stage treatment, 13 staged treatment, and 3 conservative management, with 112 aneurysms treated in total. One patient with multiple aneurysms suffered rupture of the untreated contralateral aneurysm 2 years after target embolization. Among 52 followed-up patients, 32 had GOS >4, 13 GOS 3, and 7 GOS ≤2. Of 42 patients with DSA follow-up, 9 showed partial neck recurrence, 2 of whom were successfully retreated, with no re-hemorrhage detected in initially treated aneurysms. Conclusions Comprehensive evaluation based on aneurysm morphology, location, rupture risk, and patient condition, combined with individualized treatment and regular follow-up, can achieve satisfactory outcomes in patients with MIA. This study's single-center retrospective limitations warrant external validation via prospective multi-center controlled trials to confirm the generalizability of our stratified treatment algorithm.
In Japan, flow diverters for unruptured intracranial aneurysms are indicated for ≥5-mm wide-neck aneurysms in the proximal arteries. Distal aneurysms are treated with stent-assisted coil embolization, but in small-caliber vessels make these challenging. The Low-profile Visualized Intraluminal Support (LVIS) device has flow-diverting properties. We evaluated stand-alone LVIS stenting for unruptured distal intracranial aneurysms. Distal vessels were defined as segments A2 or more distal, M2 or more distal, and distal segments of the posterior inferior cerebellar artery (PICA), anterior inferior cerebellar artery (AICA), superior cerebellar artery (SCA), or posterior cerebral artery. We reviewed 39 patients treated with LVIS. Six with unruptured distal aneurysms underwent stand-alone LVIS stenting. We assessed morphology, procedural details, angiographic outcomes, change in vessel angle, and complications, with follow-up via magnetic resonance or digital subtraction angiography. LVIS deployment was successful in all six patients. Follow-up imaging showed complete obliteration in four, size reduction in one, and regrowth in one, which required additional transcell coil embolization. No ischemic or hemorrhagic complications occurred. Parent artery straightening and flow stagnation were observed immediately after deployment in all non-recurrent cases. Stand-alone LVIS stenting for unruptured distal aneurysms is feasible and safe. Parent artery straightening may predict favorable response.
Background Traumatic intracranial aneurysms are rare, and those arising from the ophthalmic artery are exceedingly uncommon. Management remains challenging because of vessel fragility and proximity to critical structures. Although flow diverters are established for unruptured internal carotid aneurysms, their role in traumatic ophthalmic artery aneurysms remains undefined. Methods A literature review was performed according to PRISMA guidelines, searching PubMed, Scopus, and Web of Science for traumatic ophthalmic artery aneurysms. Only lesions originating from the ophthalmic artery itself were included; para-ophthalmic internal carotid artery aneurysms with neck arising from the internal carotid artery wall were explicitly excluded. Clinical presentation, imaging findings, treatments, and outcomes were summarized. Additionally, we report an illustrative case successfully treated with a flow diverter. Results Fourteen reports describing 15 patients were included. Most were treated with surgical clipping or endovascular coiling, and none involved flow diverter use. Ophthalmic artery sacrifice was required in 9 of 12 treated patients (75%). Among all 15 reported cases, visual recovery occurred in only one case (6.7%). In our illustrative case, a 41-year-old man with post-traumatic visual decline was treated with a flow diverter covering the ophthalmic artery origin, achieving complete occlusion at 6 months and marked visual improvement by 1 year. Conclusions In selected patients, flow diversion may be a feasible reconstructive option for traumatic ophthalmic artery aneurysms when parent artery sacrifice is undesirable. However, this conclusion is based on a single illustrative case in this rare pathology, and further case accumulation is needed to better define the safety, durability, and indications of this approach.
Background Glioblastoma is a highly malignant brain tumor for which maximal safe resection remains essential for treatment. However, deep-seated lesions often require invasive surgery. Herein, we describe the technical feasibility of a one-burr hole endoscopic resection for selected deep-seated glioblastoma cases. Methods Between 2017 and 2025, six patients with glioblastoma underwent burr hole endoscopic tumor resection. Neuronavigation-guided transcortical access was established using a 10-mm transparent sheath. Continuous intraoperative navigation was achieved by registering a ventricular puncture cannula, a transparent sheath, and a suction device in the navigation system. Photodynamic diagnosis (PDD) was applied for tumor visualization. The extent of resection was evaluated by volumetric analysis of the target lesion on pre- and post-operative MRI. Results All procedures were completed through a single burr hole without conversion to conventional craniotomy. The mean operative time was approximately 120 min. The mean extent of resection of the target lesion was 96.9% (range, 89.1–100%). In one patient who received bevacizumab, a progressive non-enhancing FLAIR lesion was successfully resected. Intraoperative orientation and hemostatic control were maintained using navigation-integrated endoscopic techniques and adjunctive hemostatic agents in all cases. One patient developed postoperative hematoma accumulation within the resection cavity; however, reoperation was not required. Conclusions One-burr hole endoscopic resection is a feasible and minimally invasive option for select deep-seated glioblastoma cases. Continuous neuronavigation, PDD assistance, and careful hemostatic strategies are important to ensure safe tumor removal through a narrow operative corridor.
Background Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly among older adults, and is associated with substantial morbidity and recurrence after surgical evacuation. Middle meningeal artery (MMA) embolization has emerged as a minimally invasive treatment intended to reduce the vascular supply to the hematoma membranes. This study evaluated preliminary short-term radiological and treatment outcomes after MMA embolization in patients with symptomatic cSDH. Methods This prospective, single-arm, single-center study enrolled 10 patients with symptomatic cSDH who underwent MMA embolization at Kafr Elsheikh University between October 2024 and October 2025. Eligible patients included those with mild neurological symptoms, high surgical risk, recurrent or refractory hematomas, or failure of conservative management. MMA embolization was performed through femoral or radial arterial access using polyvinyl alcohol particles or a liquid embolic agent. Clinical assessment and non-contrast computed tomography were performed after the procedure and at 2 and 6 weeks. Results Bilateral hematomas were present in 4(40%) patients. At 2 weeks, 7(70%) patients demonstrated a reduction in hematoma size of at least 50%; complete disappearance was subsequently documented in 2 of these 7 patients. Inadequate hematoma resolution necessitated post-embolization surgical evacuation in 3(30%) patients; therefore, 7(70%) patients did not undergo subsequent surgery during the 6-week follow-up. Procedure-related complications occurred in 2(20%) patients: one femoral puncture-site groin hematoma that resolved with conservative management and one MMA dissection without clinical sequelae. No other procedure-related adverse events were reported. Conclusion MMA embolization was associated with substantial short-term radiological reduction of cSDH. Seven of 10 patients demonstrated a reduction in hematoma size of at least 50% at 2 weeks, and 7/10 patients did not require subsequent surgical evacuation during 6 weeks of follow-up. Two procedure-related complications were observed: one groin hematoma that resolved with conservative management and one MMA dissection without clinical sequelae.
Objective To evaluate the long-term efficacy of Transforaminal Percutaneous Endoscopic Discectomy and Foraminoplasty (TPED-F) as a salvage procedure for symptomatic recurrence following lumbar dynamic stabilization. Methods A retrospective analysis was conducted on 20 consecutive patients who underwent TPED-F for recurrent radiculopathy or neurogenic claudication after lumbar dynamic stabilization. All procedures were performed under local anesthesia. Clinical outcomes were assessed using the leg visual analog scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), and maximum single-walk distance (MSWD) preoperatively and at multiple postoperative intervals (3 months, 9 months, and final follow-up). Patient satisfaction was graded via the modified Macnab criteria. Complications and reoperations were recorded. The mean follow-up duration was 6.2 years. Results The cohort demonstrated significant and sustained improvements across all outcome measures. The low back and leg VAS score decreased markedly from a preoperative median of 6.0 to 1.0 at final follow-up (p < 0.001). JOA scores improved from 14.2 to 23.1, ODI scores decreased from 56.8% to 20.6%, and MSWD increased from 80.0 m to 804.5 m (all p < 0.001). According to the Macnab criteria, 95% of patients achieved an excellent or good outcome. No major intraoperative complications occurred, and no patient required reoperation during the follow-up period. Conclusion For carefully selected patients without segmental instability, TPED-F appears to be a feasible and safe salvage procedure, providing significant pain relief and functional improvement at long-term follow-up in this small case series. However, given the retrospective design, small sample size, and lack of a control group, these findings should be considered preliminary and hypothesis-generating. Comparative studies are needed before any conclusions can be drawn regarding its efficacy relative to open revision surgery.
Background Anterior skull base meningiomas (ASBMs) are heterogeneous, and evidence for supraorbital keyhole surgery is derived from small retrospective series with inconsistent outcome definitions. This review summarizes outcomes and assesses the comparability of available evidence. Methods This PRISMA 2020-compliant systematic review searched PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, and CENTRAL through 31 December 2025; PubMed/MEDLINE and citation tracking were updated through 9 August 2026. MEDLINE was searched through PubMed and treated as one source. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Outcome definitions, analytic eligibility, and cohort overlap were verified before quantitative synthesis. The primary gross-total resection (GTR) meta-analysis included only cohorts defining complete resection as radiographic GTR or 100% extent of resection (EOR); heterogeneous study-defined complete-resection data were analyzed separately. Visual improvement was pooled only with clear patient-level eligible denominators and postoperative reassessment. Random-effects single-proportion analyses used logit transformation, Paule–Mandel variance estimation, and Hartung–Knapp confidence intervals. Results Twelve studies were included qualitatively. Three definition-compatible cohorts contributed 49 GTR events among 51 patients, yielding a pooled proportion of 95.0% (95% confidence interval [CI], 90.0–97.6%; I2 = 0%). An exploratory analysis of eight cohorts with heterogeneous complete-resection definitions included 92 events among 101 patients and yielded 87.4% (95% CI, 72.2–94.9%; I2 = 28.8%). Five cohorts contributed 20 visual improvements among 30 patients with documented preoperative deficits, yielding 66.3% (95% CI, 27.1–91.2%; I2 = 39.8%). Complications and recurrence were summarized descriptively because ascertainment and follow-up were inconsistent. Conclusions Supraorbital keyhole surgery can achieve high complete-resection rates in selected ASBM cohorts. However, the evidence remains limited by retrospective designs, clinical heterogeneity, small samples, variable definitions, and selective reporting. These estimates should be interpreted as descriptive benchmarks rather than evidence of superiority or equivalence to alternative approaches.
Objective To evaluate the clinical efficacy, radiographic outcomes, and safety of unilateral biportal endoscopic unilateral laminotomy for bilateral decompression (UBE-ULBD) with en bloc ligamentum flavum resection for lumbar spinal stenosis (LSS), and to identify a safe, efficient surgical method that observed complications. Materials and methods This study included 178 patients who underwent UBE-ULBD across 263 spinal levels between January 2022 and December 2024. Inclusion criteria were radiographically confirmed LSS, failure of conservative treatment for at least three months, and Schizas grade B to D stenosis. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain. Radiological parameters, including dural sac cross-sectional area (CSDA) and facet joint preservation rate, were measured on MRI using ImageJ software. Statistical analyses were performed using the Wilcoxon signed-rank test and paired t-test. Results Postoperatively, VAS scores for back pain and leg pain decreased significantly from 6.36 ± 1.64 and 6.55 ± 1.71 to 1.96 ± 0.69 and 2.17 ± 0.87, respectively (P < 0.001). The ODI improved from 65.50 ± 6.49 to 26.68 ± 4.99 (P < 0.001). CSDA increased markedly from 54.41 ± 21.44 mm2 to 164.23 ± 46.52 mm2 (P < 0.001). Postoperatively, the ipsilateral inferior articular process width decreased from 9.06 ± 2.09 mm to 5.57 ± 2.25 mm, whereas the contralateral width decreased from 9.12 ± 2.18 mm to 8.18 ± 2.23 mm. The ipsilateral and contralateral facet joint preservation rates were 60.03% ± 16.45% and 89.32% ± 9.16%, respectively. Complications included five cases (2.8%) of asymptomatic dural tears, all of which healed uneventfully without sequelae; no patient required revision surgery. Conclusions UBE-ULBD with en bloc ligamentum flavum resection significantly improved short-term clinical and radiographic outcomes in LSS patients, with favorable facet preservation and low complications. However, comparative studies with extended follow-up are needed. This technique appears a safe, effective minimally invasive option for selected patients.
Background Post-traumatic pseudoaneurysms of the superficial temporal artery (STA) represent less than 1% of all traumatic aneurysms, making their diagnosis challenging. Among the pediatric population, the clinical presentation often assimilates to more common conditions such as simple hematomas, dermoid cysts, arteriovenous fistulas, vascular malformations or scalp abscesses. This clinical overlap increases the likelihood of misdiagnosis. Case presentation A 6-year-old girl presented with an enlarging, pulsatile frontotemporal mass that appeared 11 days after minor cranial trauma. Imaging demonstrated a subcutaneous saccular lesion arising from the frontal branch of the left STA, with contrast enhancement consistent with adjacent arterial vessels. After multidisciplinary assessment, common pediatric soft-tissue diagnoses were excluded, leading to the selection of open surgical intervention given the high risk of pressure-induced skin necrosis over the thin pediatric scalp. Results Intraoperative findings confirmed a pseudoaneurysm. Definitive excision via an arciform incision with proximal and distal STA ligation achieved immediate mass effect relief without complications. Histopathology showed a reactive vascular wall without evidence of old thrombus. At three-month follow-up, wound healing was satisfactory, local swelling was fully resolved, and there was no clinical evidence of recurrence, with favorable cosmetic results. Conclusion Maintaining a high index of clinical suspicion for STA pseudoaneurysm is vital when evaluating delayed post-traumatic scalp swellings, as these are frequently misidentified in the pediatric emergency setting. The surgical excision approach remains a definitive and safe therapeutic option.
Objectives Malpractice litigation imposes substantial pressures on neurosurgeons, altering clinical practice and negatively impacting physician well-being. This study aims to identify and characterize the 50 most-cited articles on neurosurgical malpractice and evaluate trends in themes, authorship, geographic region, and study design. Methods A bibliometric analysis was performed using all databases within Web of Science. Articles were included if their primary focus involved neurosurgical malpractice or litigation. Studies addressing informed consent, defensive medicine, or neurosurgical procedures without explicit reference to malpractice or litigation were excluded. For each article, citation metrics, authorship, study themes, and design were recorded. Citations per year (CPY) and citation density were calculated. A Mann-Whitney U test assessed differences in citation counts between articles with and without a Juris Doctor (J.D.) author. Keyword network analysis was performed to assess thematic clustering. Results The top 50 articles acquired 1671 citations (mean 33 ± 28). Publications peaked in 2015, while citation density showed a slight decline over time. Spine-related topics represented 48% of articles. Retrospective designs were most common (58%), most frequently utilizing legal databases. The United States contributed 70% of publications, predominantly from the Northeast region. Articles with a J.D. co-author had higher mean citation count than those without, but this difference was not statistically significant (39.1 ± 30.7 vs. 32.5 ± 27.2; P = 0.604). Conclusions Highly cited neurosurgical malpractice literature is dominated by spine-related research and reflects the influence of litigation on clinical practice patterns. Influential scholarship on neurosurgical malpractice may help inform strategies to reduce liability risk in neurosurgical care.
Spontaneous otogenic pneumocephalus (SOP) is a rare condition in which air enters the intracranial space through the temporal bone. It requires an extracranial-intracranial fistula and a pressure gradient for air entry. SOP can result from congenital or acquired defects in the temporal bone. It is often associated with chronic intracranial hypertension or chronic elevations in middle ear pressure. Surgery for SOP aims to relieve tension and close fistulous connections. We summarize 78 cases of SOP reported in the literature, along with hypothesized etiologies. A case of tension SOP within the temporal lobe due to a tegmen defect and frequent sneezing is also presented.
ObjectiveTo construct a nomogram model based on the triglyceride-glucose index (TyG) and other factors to predict in-stent stenosis (ISS) after flow diverter (FD) treatment in patients with intracranial aneurysms. Methods A total of 224 patients with intracranial aneurysms admitted to the hospital from October 2015 to October 2024 were selected. All patients underwent FD treatment. Based on the occurrence of ISS 6 months after treatment, they were divided into an ISS group and a non-ISS group. Clinical data and preoperative TyG were compared between the two groups. A logistic regression model was used to analyze the influencing factors of ISS after FD treatment in patients with intracranial aneurysms, and a corresponding nomogram was constructed. Receiver operating characteristic (ROC) curves and calibration curves were used to evaluate the predictive efficacy and calibration of the nomogram. Results Logistic regression analysis showed that smoking (OR = 2.104, 95% CI: 1.268–3.490), aneurysm diameter (OR = 1.644, 95% CI: 1.062–2.543), FD malapposition (OR = 3.054, 95% CI: 1.419–6.574), and TyG (OR = 2.676, 95% CI: 1.394–5.139) were risk factors for ISS after FD treatment in patients with intracranial aneurysms (P < 0.05). The independent influencing factors of ISS after FD treatment were incorporated into the logistic regression equation: Logit(P) = −15.737+ 0.744 × 1+ 0.497 × 2+ 1.117 × 3+ 0.984 × 4. The ROC curve showed that the nomogram had a sensitivity of 92.68%, a specificity of 87.21%, and an area under the curve (AUC) of 0.925 (95% CI, 0.881–0.957) for predicting ISS after FD treatment. The Hosmer-Lemeshow test indicated no significant difference between the predicted probability and the actual probability of the nomogram for predicting ISS after FD treatment (χ2 = 7.823, P = 0.451). Conclusion Smoking, aneurysm diameter, FD malapposition, and TyG are risk factors for ISS after FD treatment in patients with intracranial aneurysms. The corresponding nomogram demonstrates good predictive efficacy upon validation.
