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World Neurosurgery

2025
2024
2023
2022
2021
2020

本篇文献由机器智能翻译

【Online】2025年6月速览(上)
  • Thalamic Cavernomas: A Systematic Review of Clinical Manifestations, Diagnostic Challenges, and Surgical Outcomes

    丘脑海绵状血管瘤:临床表现、诊断挑战及手术预后的系统评价

    Thalamic cavernomas represent rare vascular malformations that embody important challenges in the clinical and surgical point of view because of their eloquent location and hemorrhagic propensity. This systematic review focuses on summarizing evidence with respect to their clinical presentation, diagnostic approach, management strategy, and outcome. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included studies from PubMed and Scopus databases. Articles were screened for relevance using predefined inclusion criteria, and data were extracted and synthesized narratively. Quality assessment was performed using the Joanna Briggs Institute checklist. A total of 15 studies involving 219 patients were included. The patients' ages ranged from newborn to 56 years, with a slight predominance of females (N = 121, 55%). Common presentations included hemorrhage (N = 171, 78.1%) and headaches (N = 123, 56.2%). Surgical resection was the most common intervention used; transcallosal approach (N = 40, 18.3%) was the most frequent. Results from pooled analyses revealed distinct trends in surgical decision-making. Approximately 28% of patients were managed conservatively (95% confidence interval [CI]: 0.12-0.43), while 72% underwent surgery (95% CI: 56.2-88.5). Preventative surgeries accounted for 30% of cases (95% CI: 0.15-0.46), whereas surgeries following a first hemorrhagic event were more common (47%; 95% CI: 0.34-0.60). Interestingly, only 5% underwent surgery after recurrent bleeding (95% CI: 0.02-0.08), suggesting a shift toward earlier intervention. Publication bias was largely absent, and findings remained robust across models. These insights highlight evolving trends in surgical timing and underscore the importance of tailored, evidence-based management for thalamic cavernomas.

    丘脑海绵状血管瘤是一种罕见的血管畸形,由于其位置关键且有出血倾向,从临床和手术角度来看都极具挑战。本系统综述旨在总结有关其临床表现、诊断方法、治疗策略和预后的相关证据。本综述遵循系统评价和Meta分析的首选报告项目指南,纳入了来自PubMed和Scopus数据库的研究。根据预先设定的纳入标准筛选相关文章,并提取和综合数据进行叙述性分析。采用乔安娜·布里格斯研究所的检查表进行质量评估。共纳入15项涉及219例患者的研究。患者年龄从新生儿到56岁不等,女性略占多数(N = 121,55%)。常见表现包括出血(N = 171,78.1%)和头痛(N = 123,56.2%)。手术切除是最常用的干预措施;经胼胝体入路(N = 40,18.3%)最为常见。汇总分析结果显示了手术决策中的明显趋势。约28%的患者接受保守治疗(95%置信区间[CI]:0.12 - 0.43),而72%接受手术治疗(95% CI:56.2 - 88.5)。预防性手术占病例的30%(95% CI:0.15 - 0.46),而首次出血事件后进行手术更为常见(47%;95% CI:0.34 - 0.60)。有趣的是,只有5%的患者在反复出血后接受手术(95% CI:0.02 - 0.08),这表明有向早期干预转变的趋势。研究基本不存在发表偏倚,且不同模型的研究结果均较为可靠。这些见解凸显了手术时机的演变趋势,并强调了针对丘脑海绵状血管瘤制定个性化、循证治疗方案的重要性。

    REF: Al-Shalchy AK, Hashim MAB, Al-Taie RH, Al-Badri SG, Abdalridha RH, Ismail M. Thalamic Cavernomas: A Systematic Review of Clinical Manifestations, Diagnostic Challenges, and Surgical Outcomes. World Neurosurg. 2025;198:123972. doi:10.1016/j.wneu.2025.123972 PMID: 40221028

  • Cerebrospinal Fluid Biomarkers in Idiopathic Normal Pressure Hydrocephalus: Bibliometric Analysis and Literature Review

    特发性正常压力脑积水脑脊液生物标志物:文献计量分析与文献综述

    Idiopathic normal pressure hydrocephalus (iNPH) is a progressive neurological disorder characterized by normal intracranial pressure, ventriculomegaly, gait disturbances, cognitive impairment, and urinary dysfunction, with an unknown etiology and predominantly affecting elderly populations. iNPH frequently coexists with Alzheimer disease (AD), and differentiating dementia-subtype iNPH from AD remains clinically challenging. In this review, we demonstrate that cerebrospinal fluid biomarkers may aid differential diagnosis, correlate with cognitive impairment, and predict shunt surgery outcomes. The cerebrospinal fluid biomarkers investigated include AD-associated markers (amyloid-β and tau proteins). Our analysis integrates bibliometric methodologies to map research trends. Advancements in understanding amyloid-β and tau pathology may offer novel diagnostic and therapeutic strategies for iNPH.

    特发性正常压力脑积水(iNPH)是一种进行性神经系统疾病,其特征为颅内压正常、脑室扩大、步态障碍、认知障碍和排尿功能障碍,病因不明,主要影响老年人群。iNPH常与阿尔茨海默病(AD)共存,临床上区分痴呆亚型iNPH和AD仍具挑战性。在这篇综述中,我们指出脑脊液生物标志物可能有助于鉴别诊断、与认知障碍相关并预测分流手术效果。所研究的脑脊液生物标志物包括与AD相关的标志物(β-淀粉样蛋白和tau蛋白)。我们的分析结合了文献计量学方法来描绘研究趋势。对β-淀粉样蛋白和tau蛋白病理认识的进展可能为iNPH提供新的诊断和治疗策略。

    REF: Bai W, Chang T, Halike K, et al. Cerebrospinal Fluid Biomarkers in Idiopathic Normal Pressure Hydrocephalus: Bibliometric Analysis and Literature Review. World Neurosurg. 2025;198:123981. doi:10.1016/j.wneu.2025.123981 PMID: 40250527

  • Pathogenic Variants and Prognosis in Meningiomas: A Systematic Review and Meta-Analysis

    脑膜瘤的致病基因突变与预后:系统评价和荟萃分析

    Intracranial meningiomas are the most common primary tumors of the central nervous system. Although generally benign, some genetic alterations can induce aggressive behavior characterized by higher recurrence rates and reduced survival. This systematic review highlights the importance of pathogenic variants, particularly TERTp and NF2, as prognostic markers in intracranial meningiomas. These findings underscore the potential of integrating genetic profiling into clinical practice to refine risk stratification and guide personalized therapeutic strategies, ultimately improving patient outcomes and quality of life.

    颅内脑膜瘤是中枢神经系统最常见的原发性肿瘤。虽然通常为良性,但一些基因改变可诱发侵袭性行为,其特征为更高的复发率和更低的生存率。这篇系统综述强调了致病基因变异,尤其是端粒酶逆转录酶启动子(TERTp)和2型神经纤维瘤病基因(NF2)作为颅内脑膜瘤预后标志物的重要性。这些发现突显了将基因谱分析纳入临床实践以优化风险分层和指导个性化治疗策略的潜力,最终改善患者的预后和生活质量。

    REF: Zuniga RDDR, Carrijo GS, do Vale MR, et al. Pathogenic Variants and Prognosis in Meningiomas: A Systematic Review and Meta-Analysis. World Neurosurg. 2025;198:123988. doi:10.1016/j.wneu.2025.123988 PMID: 40254182

  • Spinal Idiopathic Hypertrophic Pachymeningitis: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes

    脊柱特发性肥厚性硬脑膜炎:诊断特征、临床管理和手术结局的系统评价

    To comprehensively review the diagnostic features, clinical management, and surgical outcomes of spinal idiopathic hypertrophic pachymeningitis (sIHP) through a systematic analysis of existing literature. sIHP presents unique diagnostic and management challenges compared to its cranial counterpart. While sharing similarities in demographic patterns and diagnostic approaches, sIHP often requires more aggressive initial management due to the risk of irreversible neurological damage from spinal cord compression. The findings underscore the need to consider sIHP in the differential for patients with progressive myelopathic symptoms without signs of neoplasm.

    通过对现有文献进行系统分析,全面回顾脊柱特发性肥厚性硬脑膜炎(sIHP)的诊断特征、临床管理和手术效果。与颅内特发性肥厚性硬脑膜炎相比,sIHP 在诊断和管理方面存在独特挑战。虽然在人口统计学特征和诊断方法上有相似之处,但由于脊髓受压可能导致不可逆神经损伤,sIHP 通常需要更积极的初始治疗。研究结果强调,对于有进行性脊髓病症状但无肿瘤迹象的患者,在鉴别诊断时应考虑 sIHP。

    REF: Balasubramanian K, Kharbat AF, Call-Orellana F, et al. Spinal Idiopathic Hypertrophic Pachymeningitis: A Systematic Review of Diagnostic Features, Clinical Management, and Surgical Outcomes. World Neurosurg. 2025;198:124008. doi:10.1016/j.wneu.2025.124008 PMID: 40288528

  • Deep Learning-Based Models for Ventricular Segmentation in Hydrocephalus: A Systematic Review and Meta-Analysis

    基于深度学习的脑积水脑室分割模型:系统评价与Meta分析

    Ventricular segmentation is a critical step in neuroimaging data evaluation, particularly in hydrocephalus. Current methods are mainly based on 2-dimensional measurements and ratios. Traditional manual and semiautomatic ventricular segmentation are time-consuming, operator-based, and lack flexibility in handling numerous radiological features. Recently, deep learning (DL) models have been developed to perform ventricular segmentation and have shown promising outcomes. The objective of the current study was to evaluate the performance of DL-based models in ventricular segmentation in the hydrocephalus setting. DL-based models have demonstrated favorable outcomes in ventricular segmentation in patients with hydrocephalus. Application of these models in clinical practice can optimize the treatment protocol and enhance the clinical outcomes of hydrocephalus patients.

    脑室分割是神经影像学数据评估中的关键步骤,在脑积水的评估中尤为重要。目前的方法主要基于二维测量和比率。传统的手动和半自动脑室分割方法耗时,依赖操作人员,并且在处理众多放射学特征方面缺乏灵活性。最近,深度学习(DL)模型已被开发用于进行脑室分割,并显示出了良好的效果。本研究的目的是评估基于深度学习的模型在脑积水情况下脑室分割中的性能。基于深度学习的模型在脑积水患者的脑室分割中已取得了良好的效果。将这些模型应用于临床实践可以优化治疗方案,改善脑积水患者的临床结局。

    REF: Hajikarimloo B, Mohammadzadeh I, Habibi MA, et al. Deep Learning-Based Models for Ventricular Segmentation in Hydrocephalus: A Systematic Review and Meta-Analysis. World Neurosurg. 2025;198:124001. doi:10.1016/j.wneu.2025.124001 PMID: 40306409

  • The Evolvement of the 100 Most Cited Articles in Spine Surgery in the Last Decade Compared to All-Time

    与有史以来情况相比,过去十年脊柱外科领域被引用次数最多的100篇文章的演变情况

    Decision-making in spine surgery is continuously shaped by advancements in the field through evidence-based medicine. This is demonstrated through the evolution of the quality and impact of scientific research within the field of spine surgery. To date, there is limited literature investigating interval changes in methodological rigor of scientific investigation within the field of spine surgery. An overall increase in the level of evidence over time within the field of spine surgery was demonstrated with an associated decreased methodologic rigor within recent nonrandomized investigations. A focus on enhancing the quality of investigation is prudent to guide evidence-based practice in spine surgery.

    脊柱外科的决策不断受到该领域循证医学进展的影响。这通过脊柱外科领域科学研究质量和影响力的演变得以体现。到目前为止,研究脊柱外科领域科学研究方法严谨性阶段性变化的文献有限。有研究显示,随着时间的推移,脊柱外科领域的证据水平总体有所提高,但近期非随机研究的方法严谨性有所下降。注重提高研究质量对于指导脊柱外科的循证实践是明智之举。

    REF: Miller M, Meade M, Nanavati R, et al. The Evolvement of the 100 Most Cited Articles in Spine Surgery in the Last Decade Compared to All-Time. World Neurosurg. 2025;198:123996. doi:10.1016/j.wneu.2025.123996 PMID: 40252694

  • Minimally Invasive Decompression versus Open Laminectomy in Multilevel Lumbar Stenosis: A Systematic Review and Meta-Analysis

    多节段腰椎管狭窄症的微创减压术与开放椎板切除术对比:系统评价与Meta分析

    This meta-analysis compares clinical outcomes of minimally invasive decompression (MID) versus open laminectomy surgery (OLS) for multilevel lumbar spinal stenosis. Our study showed important statistical differences between the groups analyzed, likely attributable to inconsistencies in standardized approaches and decompression techniques across studies. Notably, MID demonstrated an advantage over OLS regarding intraoperative blood management.

    这项荟萃分析比较了微创减压术(MID)与开放性椎板切除术(OLS)治疗多节段腰椎管狭窄症的临床结局。我们的研究显示,所分析的两组之间存在显著的统计学差异,这可能归因于各项研究在标准化方法和减压技术方面的不一致。值得注意的是,在术中血液管理方面,微创减压术相较于开放性椎板切除术显示出优势。

    REF: Sharma E, da Silva Lobo KE, Ayesha A, et al. Minimally Invasive Decompression versus Open Laminectomy in Multilevel Lumbar Stenosis: A Systematic Review and Meta-Analysis. World Neurosurg. 2025;198:124031. doi:10.1016/j.wneu.2025.124031 PMID: 40339745

  • Artificial Intelligence–Based Radiomic Model in Craniopharyngiomas: A Systematic Review and Meta-Analysis on Diagnosis, Segmentation, and Classification

    颅咽管瘤中基于人工智能的影像组学模型:关于诊断、分割和分类的系统评价与荟萃分析

    Craniopharyngiomas (CPs) are rare, benign brain tumors originating from Rathke's pouch remnants, typically located in the sellar/parasellar region. Accurate differentiation is crucial due to varying prognoses, with adamantinomatous CPs having higher recurrence and worse outcomes. Magnetic resonance imaging struggles with overlapping features, complicating diagnosis. This study evaluates the role of artificial intelligence (AI) in diagnosing, segmenting, and classifying CPs, emphasizing its potential to improve clinical decision-making, particularly for radiologists and neurosurgeons. AI-based models show strong potential in enhancing the diagnostic accuracy and clinical decision-making process for CPs. These findings support the use of AI tools for more reliable preoperative assessment, leading to better treatment planning and patient outcomes. Further research with larger datasets is needed to optimize and validate AI applications in clinical practice.

    颅咽管瘤(CPs)是一种罕见的良性脑肿瘤,起源于拉特克囊残余组织,通常位于鞍区/鞍旁区域。由于不同类型颅咽管瘤的预后不同,准确鉴别至关重要,其中成釉细胞型颅咽管瘤的复发率更高,预后更差。磁共振成像因特征重叠而难以准确诊断,增加了诊断的复杂性。本研究评估了人工智能(AI)在颅咽管瘤诊断、分割和分类中的作用,强调了其在改善临床决策方面的潜力,尤其对放射科医生和神经外科医生而言。基于人工智能的模型在提高颅咽管瘤诊断准确性和临床决策过程方面显示出巨大潜力。这些研究结果支持使用人工智能工具进行更可靠的术前评估,从而实现更好的治疗规划和改善患者预后。需要利用更大的数据集开展进一步研究,以优化并验证人工智能在临床实践中的应用。

    REF: Mohammadzadeh I, Hajikarimloo B, Niroomand B, et al. Artificial Intelligence-Based Radiomic Model in Craniopharyngiomas: A Systematic Review and Meta-Analysis on Diagnosis, Segmentation, and Classification. World Neurosurg. 2025;198:124050. doi:10.1016/j.wneu.2025.124050 PMID: 40345380

  • Constructing a Digital Bridge: A Systematic Review Assessing Electronic Medical Record and Telehealth Implementation for Neurosurgery in Uganda

    搭建数字桥梁:乌干达神经外科电子病历与远程医疗实施情况的系统评价

    Neurosurgical care in Uganda faces significant challenges due to workforce shortages, infrastructure limitations, and a lack of digital health tools. Implementing electronic medical records (EMRs) and telehealth could improve neurosurgical outcomes, but adoption remains low. This systematic review examines barriers and facilitators to EMR and telehealth implementation in Ugandan neurosurgery to identify opportunities for improvement. Addressing Uganda's digital health gaps requires cost-effective and scalable strategies, including mobile-based EMRs, teleconsultation frameworks, and structured workforce training. Future research should focus on developing implementation models tailored to low-resource settings, ensuring feasibility and sustainability. This study aims to contribute to the growing discourse on digital solutions for resource-limited healthcare, with a particular emphasis on innovation in global neurosurgical care.

    乌干达的神经外科护理因医护人员短缺、基础设施有限以及缺乏数字健康工具而面临重大挑战。实施电子病历(EMRs)和远程医疗本可以改善神经外科治疗效果,但普及程度仍然较低。本系统评价探讨了乌干达神经外科在实施电子病历和远程医疗方面的障碍与促进因素,以找出改进的机会。解决乌干达数字健康领域的差距需要具有成本效益且可扩展的策略,包括基于移动设备的电子病历、远程会诊框架以及系统化的医护人员培训。未来的研究应专注于开发适合资源匮乏环境的实施模式,确保其可行性和可持续性。本研究旨在为关于资源有限地区医疗保健数字解决方案的讨论添砖加瓦,尤其着重于全球神经外科护理领域的创新。

    REF: Roach CS, Pham A, Shawwa JJ, et al. Constructing a Digital Bridge: A Systematic Review Assessing Electronic Medical Record and Telehealth Implementation for Neurosurgery in Uganda. World Neurosurg. 2025;198:124048. doi:10.1016/j.wneu.2025.124048 PMID: 40345385

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