Antibiotic-Impregnated Catheters for Ventriculoperitoneal Shunt in Neonates and Infants: A Systematic Review and Meta-Analysis

新生儿和婴儿脑室腹腔分流术用抗生素浸渍导管：系统评价与Meta分析

Ventriculoperitoneal shunt (VPS) is the standard treatment for hydrocephalus in neonates and infants, but is commonly complicated by shunt infections. Antibiotic-impregnated catheters (AICs) have been introduced to mitigate infection risk; however, their effectiveness remains uncertain. AICs substantially reduce infection risk and delay infection onset in neonates and infants undergoing VPS, particularly for gram-positive bacteria. Routine use is recommended.

脑室腹腔分流术（VPS）是新生儿和婴儿脑积水的标准治疗方法，但常并发分流管感染。含抗生素导管（AICs）已被引入以降低感染风险；然而，其有效性仍不确定。含抗生素导管可显著降低接受脑室腹腔分流术的新生儿和婴儿的感染风险并延迟感染发生时间，尤其是针对革兰氏阳性菌。建议常规使用。

REF: Fagundes W, Ahmed AR, Silva YP, et al. Antibiotic-Impregnated Catheters for Ventriculoperitoneal Shunt in Neonates and Infants: A Systematic Review and Meta-Analysis. World Neurosurg. 2025;201:124195. doi:10.1016/j.wneu.2025.124195 PMID: 40545034

Pathophysiological Mechanisms for Intracranial Aneurysms

颅内动脉瘤的病理生理机制

Intracranial aneurysms (IAs) represent a prevalent cerebrovascular disorder characterized by localized abnormal dilation of cerebral arterial walls. Although the majority of IAs remain clinically asymptomatic, their rupture can lead to subarachnoid hemorrhage, resulting in severe disability or even mortality. With advancements in modern imaging technologies, an increasing number of unruptured aneurysms are being detected, with an estimated prevalence of 2% to 3% in the adult population. The formation of IAs involves a complex interplay of genetic, environmental, and pathophysiological factors. This review comprehensively examines the pathophysiological mechanisms underlying IAs, including vascular wall abnormalities, hemodynamic alterations, and inflammatory responses. Although surgical interventions, such as aneurysm clipping and endovascular coil embolization, remain the primary treatment modalities, their associated complication rates remain significant. Consequently, the development of noninvasive therapeutic strategies, particularly those targeting pharmacological interventions, is of paramount importance. Future research should focus on precision medicine approaches based on individual genetic and hemodynamic profiles to enhance treatment efficacy and patient outcomes.

颅内动脉瘤（IAs）是一种常见的脑血管疾病，其特征是脑动脉壁局部异常扩张。尽管大多数颅内动脉瘤在临床上无症状，但破裂后可导致蛛网膜下腔出血，造成严重残疾甚至死亡。随着现代影像学技术的进步，越来越多的未破裂动脉瘤被检测出来，据估计，成年人中的患病率为2%至3%。颅内动脉瘤的形成涉及遗传、环境和病理生理等多种因素的复杂相互作用。本综述全面探讨了颅内动脉瘤的病理生理机制，包括血管壁异常、血流动力学改变和炎症反应。虽然手术干预，如动脉瘤夹闭术和血管内弹簧圈栓塞术仍然是主要的治疗方式，但相关并发症发生率仍然较高。因此，开发非侵入性治疗策略，特别是针对药物干预的策略至关重要。未来的研究应聚焦于基于个体遗传和血流动力学特征的精准医学方法，以提高治疗效果和患者预后。

REF: Huang Z, Ling C. Pathophysiological Mechanisms for Intracranial Aneurysms. World Neurosurg. 2025;201:124273. doi:10.1016/j.wneu.2025.124273 PMID: 40645480

Comparing Gabapentin and Pregabalin for Perioperative Pain Management in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis

加巴喷丁与普瑞巴林用于腰椎手术围手术期疼痛管理的比较：一项系统评价与荟萃分析

The effectiveness of gabapentin (GBP) and pregabalin (PGB) in mitigating acute postoperative pain following lumbar surgery remains understudied. This study assessed the effectiveness of GBP and PGB in mitigating acute postoperative pain following lumbar spine surgery, measured through patient-reported outcome measures such as visual analog scale (VAS) pain scores and the 24-hour morphine requirement. Definitive conclusions regarding the efficacy of GBP and PGB in managing acute postoperative pain remain limited. Well-designed randomized controlled trials with standardized protocols are needed to clarify their role in perioperative pain management following lumbar spine surgery.

加巴喷丁（GBP）和普瑞巴林（PGB）减轻腰椎手术后急性疼痛的效果仍未得到充分研究。本研究评估了GBP和PGB减轻腰椎手术后急性疼痛的效果，通过患者报告结局指标进行衡量，如视觉模拟评分法（VAS）疼痛评分和24小时吗啡需求量。关于GBP和PGB在管理术后急性疼痛方面的疗效，目前仍难以得出明确结论。需要开展设计良好、遵循标准化方案的随机对照试验，以明确它们在腰椎手术围手术期疼痛管理中的作用。

REF: Ebada A, Bever N, Carron CJ, et al. Comparing Gabapentin and Pregabalin for Perioperative Pain Management in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis. World Neurosurg. 2025;201:124284. doi:10.1016/j.wneu.2025.124284 PMID: 40653011

Early-Onset Sunken Brain Syndrome: An Exploratory Review of Risk Determinants and Surgical Implications

早发型脑萎缩综合征：风险决定因素及手术意义的探索性综述

Sunken brain syndrome (SBS) is a severe but preventable complication of decompressive craniectomy (DC), characterized by paradoxical herniation, cortical compression, and neurological decline. Despite rising incidence, early-onset SBS (≤3 months post-DC) remains poorly understood. This study integrates a case-informed review and literature-based analysis to explore possible contributors to SBS development. Motivated by a clinical observation of a 50-year-old woman with aneurysmal subarachnoid hemorrhage, who developed SBS 7 weeks post-DC, we reviewed 65 early-onset SBS cases to identify risk patterns. Her clinical course raised concerns about underrecognized risk factors and limited preventive strategies incorporating vigilant postoperative monitoring. Patients were categorized by clinical and pathophysiological characteristics. Cardiovascular (42%) and neurological (38%) comorbidities were most common. Those with intracranial hemodynamic or hydrodynamic instability, particularly sustained hypoperfusion or prolonged cerebrospinal fluid disturbance, developed SBS more rapidly. We used a weighted risk-scoring model to classify patients into low-, medium-, and high-risk groups. Cumulative incidence analysis showed that high-risk patients developed SBS earlier (median: 30 days, interquartile range: 21-55) than low-risk ones (median: 89 days, interquartile range: 60-89), suggesting a link between risk burden and SBS acceleration. Cranioplasty within 90 days post-DC demonstrated better functional outcomes than delayed or no cranioplasty. Conservative measures were also effective when applied rapidly, underlining the value of multimodal neuromonitoring in catching early symptoms. While this study offers a hypothesis-generating framework for future research to develop structured models for early-onset SBS prevention, its exploratory nature and small sample size make larger cohorts necessary for validation.

脑塌陷综合征（SBS）是去骨瓣减压术（DC）的一种严重但可预防的并发症，其特征为反常性脑疝形成、皮质受压和神经功能恶化。尽管发病率不断上升，但对于早发型SBS（DC术后≤3个月）的认识仍十分有限。本研究结合病例报告和文献分析，探讨了可能导致SBS发生的因素。受一名50岁患动脉瘤性蛛网膜下腔出血女性患者的临床观察启发，该患者在DC术后7周出现SBS，我们回顾了65例早发型SBS病例以确定风险模式。她的临床病程引发了对未被充分认识的危险因素以及包含术后严密监测的预防策略有限的担忧。根据临床和病理生理特征对患者进行分类。心血管（42%）和神经（38%）合并症最为常见。那些存在颅内血流动力学或流体动力学不稳定，特别是持续低灌注或脑脊液长期紊乱的患者，发生SBS的速度更快。我们使用加权风险评分模型将患者分为低、中、高风险组。累积发病率分析显示，高风险患者比低风险患者更早发生SBS（中位数：30天，四分位间距：21 - 55天 vs 中位数：89天，四分位间距：60 - 89天），这表明风险负担与SBS加速发生之间存在关联。DC术后90天内进行颅骨修补术比延迟或不进行颅骨修补术显示出更好的功能结局。保守治疗措施若能迅速实施也有效，这凸显了多模式神经监测在捕捉早期症状方面的价值。虽然本研究为未来研究提供了一个生成假设的框架，以开发早发型SBS的结构化预防模型，但其探索性性质和小样本量使得需要更大的队列进行验证。

REF: Mehrvar R, Ebrahimi MJ, Eini P, et al. Early-Onset Sunken Brain Syndrome: An Exploratory Review of Risk Determinants and Surgical Implications. World Neurosurg. 2025;201:124267. doi:10.1016/j.wneu.2025.124267 PMID: 40639755

A Systematic Review with a Meta-Analysis of the Morphological Variants of the Corpus Callosum: Related Neurocognitive Clinical Implications

一项关于胼胝体形态变异的系统评价及荟萃分析：相关神经认知临床意义

Corpus callosum agenesis (CCA) occurs in approximately 1 in every 4000 births and is identified in 3-5% of individuals evaluated through neuroimaging for neurodevelopmental disorders. The combined prevalence of CCA and hypoplasia is estimated to range from 1.8 to 10 in every 10,000 births. Early diagnosis of CCA during the fetal stage can enable specialists to implement more effective treatments and reduce the likelihood of neurofunctional impairments. Furthermore, understanding the morphological characteristics of CCA can assist in making an early and accurate diagnosis, minimizing the need for differential diagnoses that could interfere with the functioning of the interhemispheric connection system and brain functional connections.

胼胝体发育不全（CCA）的发生率约为每4000例活产中有1例，在因神经发育障碍接受神经影像学评估的个体中，有3 - 5%被确诊为此病。CCA和胼胝体发育不良的综合患病率估计为每10000例活产中有1.8至10例。在胎儿期对CCA进行早期诊断，可使专家实施更有效的治疗，并降低神经功能障碍的可能性。此外，了解CCA的形态特征有助于早期准确诊断，减少可能干扰半球间连接系统和大脑功能连接的鉴别诊断需求。

REF: Valenzuela-Fuenzalida JJ, Orellana-Hidalgo S, Baeza-Garrido V, et al. A Systematic Review with a Meta-Analysis of the Morphological Variants of the Corpus Callosum: Related Neurocognitive Clinical Implications. World Neurosurg. 2025;201:124317. doi:10.1016/j.wneu.2025.124317 PMID: 40712849

Surgery for Symptomatic Spinal Metastases of Glioblastoma

胶质母细胞瘤有症状脊髓转移灶的手术治疗

Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor in adults, accounting for 12-20% of intracranial neoplasms. Spinal metastases from GBM are rare, occurring in only 0.4-2.0% of cases. Due to their rarity, the role of surgical resection remains poorly defined, particularly regarding survival and symptom control. This study presents an illustrative case and a systematic review evaluating outcomes of surgical intervention in symptomatic spinal GBM metastases. Surgical resection may offer palliative benefit and modest survival advantage in selected patients with spinal GBM metastases. Despite a poor overall prognosis, symptom control appears improved with surgery. Further research is warranted to guide evidence-based treatment strategies.

多形性胶质母细胞瘤（GBM）是成人中最常见的原发性恶性脑肿瘤，占颅内肿瘤的12 - 20%。GBM的脊髓转移较为罕见，仅发生于0.4 - 2.0%的病例中。由于其罕见性，手术切除的作用仍不明确，尤其是在生存和症状控制方面。本研究展示了一个典型病例，并进行了系统综述，以评估有症状的GBM脊髓转移患者手术干预的效果。对于部分GBM脊髓转移患者，手术切除可能带来姑息性益处，并在一定程度上延长生存期。尽管总体预后较差，但手术似乎能改善症状控制。有必要开展进一步研究，以指导循证治疗策略。

REF: Venkatesh V, Chidambaram S, Santos AN, et al. Surgery for Symptomatic Spinal Metastases of Glioblastoma. World Neurosurg. 2025;201:124327. doi:10.1016/j.wneu.2025.124327 PMID: 40716735

Minimizing Intraoperative Blood Loss During Lumbar Vertebrectomy for Spinal Metastasis of Renal Neoplasm: Specific Radiological Embolization Technique

肾肿瘤脊柱转移腰椎椎体切除术术中减少失血：特定放射栓塞技术

Clear cell renal cell carcinoma is the most common malignant renal tumor, sometimes causing highly vascularized vertebral metastases. If the metastasis is isolated, en bloc resection of the lesion should be discussed. Vertebrectomy for curative oncologic purposes carries a significant risk of bleeding. We report a case in our center of a patient who underwent a special embolization technique prior to vertebrectomy, which significantly reduced intraoperative blood loss. Lumbar vertebrectomy is a surgical technique with a high risk of hemorrhage in the context of highly vascularized spinal metastasis. Blood loss must be reduced by the surgeon's knowledge of lumbar vascular anatomy, the use of conventional hemostasis techniques, and rapid tumor resection. Preoperative embolization of the tumor's feeder vessels was performed bilaterally and distally, using simultaneous arterial catheterization of the right and left vertebral vascular pedicules, under balloon inflation using the "pressure cooker" technique, and it also significantly reduces intraoperative blood loss.

透明细胞肾细胞癌是最常见的肾脏恶性肿瘤，有时会导致高血运的椎体转移。如果转移灶孤立，应考虑对病灶进行整块切除。出于肿瘤根治目的的椎体切除术存在显著的出血风险。我们报告了本中心的一例患者，该患者在椎体切除术前接受了一种特殊的栓塞技术，这显著减少了术中出血量。在高血运脊柱转移瘤的情况下，腰椎椎体切除术是一种出血风险较高的手术技术。外科医生需了解腰椎血管解剖结构、使用常规止血技术并快速切除肿瘤，以减少出血量。通过同时对左右椎血管蒂进行动脉插管，采用“高压锅”技术在球囊扩张状态下，对肿瘤供血血管进行双侧远端术前栓塞，这也能显著减少术中出血量。

REF: Bouare F, Varnier Q, Noureldine MHA, et al. Minimizing Intraoperative Blood Loss During Lumbar Vertebrectomy for Spinal Metastasis of Renal Neoplasm: Specific Radiological Embolization Technique. World Neurosurg. 2025;201:124243. doi:10.1016/j.wneu.2025.124243 PMID: 40619054

Minimally Invasive Resection of Lumbar Schwannomas: Expanding the Role of the Transpars Approach

腰椎神经鞘瘤的微创切除：扩大经椎弓根入路的应用范围

Lumbar nerve root schwannomas are rare tumors that can cause debilitating radicular pain and motor dysfunction due to nerve root compression. This study introduces a novel minimally invasive transpars approach for their removal, aiming to preserve spinal stability while ensuring complete resection. The transpars approach represents a safe and effective alternative to traditional methods for managing lumbar nerve root schwannomas. It minimizes invasiveness, avoids spinal stabilization, and allows for rapid postoperative recovery.

腰神经根神经鞘瘤是一种罕见的肿瘤，由于神经根受压，可导致使人虚弱的神经根性疼痛和运动功能障碍。本研究介绍了一种新型的微创经椎弓根入路方法来切除此类肿瘤，旨在确保完全切除的同时保留脊柱稳定性。经椎弓根入路是治疗腰神经根神经鞘瘤的一种安全有效的替代传统方法。它将手术创伤降至最低，无需进行脊柱固定，且能让患者术后快速康复。

REF: Angelini C, De Bonis P. Minimally Invasive Resection of Lumbar Schwannomas: Expanding the Role of the Transpars Approach. World Neurosurg. 2025;201:124241. doi:10.1016/j.wneu.2025.124241 PMID: 40619057

Transvenous Embolization of a Ventral Spinal Pial Arteriovenous Fistula: A Technical Note

脊髓腹侧软膜动静脉瘘的经静脉栓塞术：技术要点

Spinal pial arteriovenous fistulas (SPAVFs) are abnormal intradural vascular connections between arteries and veins on the pial surface and lead to debilitating neurological deficits due to direct or indirect affection of the spinal cord. Open surgery and transarterial embolization offer a cure in most cases; however, some lesions can be very challenging and carry extremely high interventional risks. We aimed to provide a technical overview of a transvenous endovascular approach in treating an SPAVF. We describe the concept of transvenous embolization of a ventral SAPV as an alternative to surgical occlusion or transarterial embolization.

脊髓软膜动静脉瘘（SPAVFs）是软膜表面动脉与静脉之间异常的硬膜内血管连接，由于直接或间接影响脊髓，会导致使人衰弱的神经功能缺损。在大多数情况下，开放手术和经动脉栓塞可以治愈；然而，一些病变可能极具挑战性，且介入风险极高。我们旨在对经静脉血管内治疗脊髓软膜动静脉瘘的方法进行技术概述。我们阐述了对腹侧脊髓软膜动静脉瘘进行经静脉栓塞的理念，将其作为手术封堵或经动脉栓塞的替代方法。

REF: Krepuska M, Thurner P, Madjidyar J, Schubert T, Kulcsar Z. Transvenous Embolization of a Ventral Spinal Pial Arteriovenous Fistula: A Technical Note. World Neurosurg. 2025;201:124268. doi:10.1016/j.wneu.2025.124268 PMID: 40639758