Brainstem Cavernous Malformations: A Systematic Review and Meta-Analysis

脑干海绵状血管畸形：系统评价与meta分析

Brainstem cavernous malformations (BSCMs) are rare yet high-risk vascular lesions with a complex clinical course due to their eloquent location. Optimal treatment remains a topic of debate. This review aims to evaluate the outcomes of different management strategies for BSCMs, with a focus on rebleeding, functional recovery, and mortality. Our findings largely reflect the cohort of hemorrhagic or symptomatic BSCMs for which microsurgical resection is generally associated with more favorable outcomes, including lower rates of recurrence, rebleeding, and mortality, when compared with radiosurgery and conservative care. Caution is warranted in extrapolating to incidental or asymptomatic lesions. Future research should also integrate advanced imaging and molecular approaches to refine risk stratification and guide management.

脑干海绵状血管畸形（BSCMs）是一种罕见但高风险的血管病变，因其位于功能重要区域，临床病程复杂。最佳治疗方法仍是一个有争议的话题。本综述旨在评估不同BSCMs管理策略的治疗效果，重点关注再出血、功能恢复和死亡率。我们的研究结果在很大程度上反映了出血性或有症状的BSCMs患者群体的情况，与放射外科治疗和保守治疗相比，显微手术切除通常会带来更理想的治疗效果，包括更低的复发率、再出血率和死亡率。将这些结果外推至偶然发现或无症状的病变时需谨慎。未来的研究还应结合先进的影像学和分子技术方法，以完善风险分层并指导治疗。

REF: Al-Shalchy AK, Al-Taie RH, Al-Rubaye AH, Patel S, Algabri MH, Ismail M. Brainstem Cavernous Malformations: A Systematic Review and Meta-Analysis. World Neurosurg. 2025;203:124452. doi:10.1016/j.wneu.2025.124452 PMID: 40915627

Incidence of Spinal Epidural Hematoma After Anterior Cervical Decompression and Fusion: Systematic Review, Meta-Analysis, and Case Report

颈椎前路减压融合术后硬脊膜外血肿的发生率：系统评价、Meta分析及病例报告

Anterior cervical discectomy and fusion (ACDF) is a common surgical procedure used to treat herniated discs, degenerative disc disease, and nerve root compression in the cervical spine. This systematic literature review aims to analyze the available literature on the incidence, risk factors, clinical considerations, and available therapies for spinal epidural hematoma (SEH) following ACDF. Although uncommon, SEH after ACDF carries significant clinical risks. Preventive measures may help mitigate its occurrence. However, the limited literature prevents a precise determination of the incidence and associated risk factors, including coagulation disorders. There is a clear need for large-scale prospective and retrospective studies with standardized reporting to more accurately define the incidence, identify risk factors, and determine the optimal management of SEH following ACDF.

颈椎前路椎间盘切除融合术（ACDF）是一种常用的外科手术，用于治疗颈椎间盘突出症、退行性椎间盘疾病和神经根受压。这篇系统文献综述旨在分析现有关于ACDF术后硬脊膜外血肿（SEH）的发病率、危险因素、临床注意事项及可用治疗方法的文献。尽管ACDF术后SEH并不常见，但它存在显著的临床风险。预防措施可能有助于减少其发生。然而，相关文献有限，无法精确确定其发病率及相关危险因素，包括凝血功能障碍。显然，需要开展大规模的前瞻性和回顾性研究，并进行标准化报告，以便更准确地确定ACDF术后SEH的发病率、识别危险因素并确定最佳治疗方案。

REF: Gregorczyk J, Fani N, Biegański M, et al. Incidence of Spinal Epidural Hematoma After Anterior Cervical Decompression and Fusion: Systematic Review, Meta-Analysis, and Case Report. World Neurosurg. 2025;203:124442. doi:10.1016/j.wneu.2025.124442 PMID: 40915628

Osteomas of the Internal Auditory Canal: A Systematic Review and Case Report

内听道骨瘤：系统评价与病例报告

Osteomas of the internal auditory canal (IAC) are rare pathologies and diagnosis requires thin-slice computed tomography imaging of the skull or magnetic resonance imaging. We report a case of bilateral florid osteomas in the IAC resulting in tinnitus and vertigo. A literature review identified 29 publications, the majority case reports, meeting our criteria involving 40 patients. We examined symptomatology, laterality, diagnostic imaging, and management strategies. Regarding diagnosis, our findings affirm the importance of thorough clinical and radiological investigations. Of utmost importance, is the assessment of patient symptoms on an individual basis to determine treatment goals, as both conservative and surgical management options have risks and benefits. While conservative treatment remains appropriate for the majority of patients, those with more severe symptoms do experience benefit from a surgical strategy. Careful case selection and management of patient expectations continue to feature as a mainstay of successful treatment. This report aims to contribute to the growing body of literature on osteomas of the IAC and ultimately guide the establishment of evidence-based nationally recognized guidelines to improve care and outcomes in patients with this rare condition.

内听道（IAC）骨瘤是一种罕见的疾病，诊断需要进行颅骨薄层计算机断层扫描成像或磁共振成像。我们报告了一例双侧弥漫性内听道骨瘤导致耳鸣和眩晕的病例。通过文献回顾，我们找到了29篇符合我们标准的出版物，其中大多数是病例报告，涉及40名患者。我们对症状表现、侧别、诊断性影像学检查和治疗策略进行了研究。在诊断方面，我们的研究结果证实了全面的临床和放射学检查的重要性。至关重要的是，要对患者的症状进行个体化评估，以确定治疗目标，因为保守治疗和手术治疗方案都有风险和益处。虽然保守治疗对大多数患者仍然是合适的，但症状较严重的患者确实能从手术治疗中获益。谨慎选择病例和管理患者的期望仍然是成功治疗的关键。本报告旨在为不断增加的关于内听道骨瘤的文献做出贡献，并最终为制定基于证据的、全国公认的指南提供参考，以改善这种罕见疾病患者的治疗和预后。

REF: Smith E, Tan SHL, Ariano M, Axon P. Osteomas of the Internal Auditory Canal: A Systematic Review and Case Report. World Neurosurg. 2025;203:124382. doi:10.1016/j.wneu.2025.124382 PMID: 40825467

Surgical Anatomy of the Third Ventricle Floor: Implications for Endoscopic Third Ventriculostomy

第三脑室底的手术解剖学：对内镜下第三脑室造瘘术的意义

Neuroendoscopy has made a breakthrough in the field of neurosurgery. Since its first application at the start of the 20th century, it has evolved enormously and become more specialized. Endoscopic Third Ventriculostomy (ETV) is a type of ventriculoscopies where the floor of the third ventricle is opened to divert the CSF from the third ventricle to the subarachnoid space. Nowadays, ETV is the gold-standard treatment for selected cases of hydrocephalus. Its success depends on, among others, the anatomy of the floor of third ventricle. From anterior to posterior, structures related to the floor of the third ventricle are the preoptic area, optic chiasm, tuber cinereum, mammillary bodies, posterior perforated substance, and tegmentum of the midbrain. The infundibulum of the pituitary gland is attached to the tuber cinereum. Inferiorly, the floor is related to the basilar artery complex. A condensation of arachnoid (known as Liliequist membrane) is sometimes present below the floor. Knowledge of the floor anatomy and its relations is crucial for successful ETV. Many anatomical variations have been described in the floor, such as thickened, thinned, partially effaced/erased, or herniated floor. Neurosurgeons have to be acquainted with the normal anatomy of the ventricles, in general, and that of the third ventricle and its variants, in particular, to ensure a successful procedure. Pre- and postsurgical MRI are important to assess and manage ETV cases. This article presents an up-to-date review of the anatomical variations in the floor of the third ventricle and their implications for the outcome of ETV.

神经内镜在神经外科领域取得了突破。自20世纪初首次应用以来，它有了巨大的发展并变得更加专业化。内镜下第三脑室造瘘术（ETV）是一种脑室镜手术，通过打开第三脑室底部，使脑脊液从第三脑室引流至蛛网膜下腔。如今，ETV是治疗某些类型脑积水的金标准方法。其成功与否，除其他因素外，还取决于第三脑室底部的解剖结构。从前往后，与第三脑室底部相关的结构依次为视前区、视交叉、灰结节、乳头体、后穿质和中脑被盖。垂体漏斗附着于灰结节。下方，第三脑室底部与基底动脉复合体相邻。有时在第三脑室底部下方会有蛛网膜增厚（即 Liliequist 膜）。了解第三脑室底部的解剖结构及其毗邻关系对于 ETV 手术的成功至关重要。已有许多关于第三脑室底部解剖变异的描述，如底部增厚、变薄、部分消失/侵蚀或膨出等。神经外科医生通常需要熟悉脑室的正常解剖结构，尤其要了解第三脑室及其变异情况，以确保手术成功。术前和术后的磁共振成像（MRI）对于评估和处理 ETV 病例非常重要。本文对第三脑室底部的解剖变异及其对 ETV 手术结果的影响进行了最新综述。

REF: Khalid Al-Khater KM. Surgical Anatomy of the Third Ventricle Floor: Implications for Endoscopic Third Ventriculostomy. World Neurosurg. 2025;203:124493. doi:10.1016/j.wneu.2025.124493 PMID: 40975308

Lymphangioma in the Neurosurgical Axis: A Review and Illustrative Case Report

神经外科轴内淋巴管瘤：综述与典型病例报告

Lymphangiomas are benign malformations of the lymphatic system that are rarely present in adults. This report describes a rare case of cervical lymphangioma in an adult patient that mimicked a schwannoma and reviews all published cases of histologically confirmed, noncomplex adult lymphangiomas involving neurological structures. A comprehensive literature search of OVID/MEDLINE and Web of Science was conducted from inception to August 29, 2025, to identify all case reports and case series involving adult patients with histologically confirmed, noncomplex lymphangiomas affecting cranial, spinal, or peripheral nerves, either by location or symptomatology. Eighteen articles comprising 18 cases were included. Data collected included lesion location, presenting symptoms, size, imaging performed, histologic findings, treatment, and follow-up. The average patient age was 46.7 years (standard deviation 19.6), with 8 males (44%), 9 females (50%), and 1 patient (6%) whose sex was not reported. The majority of patients experienced neurological symptoms (n=14, 78%), most commonly pain (50%), paresthesia (44%), and weakness (17%); 2 patients (11%) presented with neck swelling and no other symptoms. All patients except 1 underwent surgical resection. Sixteen patients (89%) had no recurrence at the last follow-up (mean follow-up time 15.2 months; standard deviation 12.2), while 2 (11%) experienced recurrence. Although rare in adults, lymphangiomas can mimic other lesions and cause neurological symptoms due to involvement of adjacent nervous system structures. Clinicians should maintain awareness of this entity to avoid misdiagnosis and guide appropriate management. This review emphasizes the importance of recognizing lymphangiomas as a relevant consideration in neurosurgical differential diagnosis.

淋巴管瘤是淋巴系统的良性畸形，在成年人中很少出现。本报告描述了一例成年患者颈部淋巴管瘤的罕见病例，该病例表现类似神经鞘瘤，并对所有已发表的、经组织学确诊的、累及神经系统结构的非复杂性成人淋巴管瘤病例进行了回顾。对OVID/MEDLINE和Web of Science进行了全面的文献检索，检索时间从建库至2025年8月29日，以确定所有涉及经组织学确诊的、非复杂性淋巴管瘤成年患者的病例报告和病例系列，这些淋巴管瘤通过位置或症状表现影响颅神经、脊神经或周围神经。共纳入了包含18个病例的18篇文章。收集的数据包括病变位置、首发症状、大小、所进行的影像学检查、组织学检查结果、治疗方法和随访情况。患者平均年龄为46.7岁（标准差19.6），其中男性8例（44%），女性9例（50%），有1例患者（6%）未报告性别。大多数患者出现神经系统症状（n = 14，78%），最常见的是疼痛（50%）、感觉异常（44%）和无力（17%）；2例患者（11%）表现为颈部肿胀，无其他症状。除1例患者外，所有患者均接受了手术切除。16例患者（89%）在最后一次随访时未复发（平均随访时间15.2个月；标准差12.2），而2例（11%）出现复发。尽管淋巴管瘤在成年人中罕见，但它可类似其他病变，并因累及邻近神经系统结构而导致神经系统症状。临床医生应保持对该疾病的认识，以避免误诊并指导合理治疗。本综述强调了在神经外科鉴别诊断中认识淋巴管瘤作为相关考虑因素的重要性。

REF: Carlson BH, Rich C, Layton P, Hudson M, Zimmerman R. Lymphangioma in the Neurosurgical Axis: A Review and Illustrative Case Report. World Neurosurg. 2025;203:124508. doi:10.1016/j.wneu.2025.124508 PMID: 41005659

The Role of Separation Surgery and Advanced Radiotherapy in Metastatic Epidural Spinal Cord Compression: A Single-Center Retrospective Study Comparing Stereotactic Body Radiation Therapy and 3D-Conformal Radiotherapy

分离手术和先进放疗在转移性硬膜外脊髓压迫症中的作用：一项比较立体定向体部放射治疗和三维适形放射治疗的单中心回顾性研究

This study aims to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) compared with 3D-conformal radiotherapy (3D-CRT) after separation surgery (SS), focusing on local disease control (LC) and overall survival (OS), in patients with metastatic epidural spinal cord compression. The combination of SS and SBRT has been demonstrated to result in superior OS and LC outcomes in comparison to 3D-CRT. While the presence of visceral metastases remains a key prognostic factor, this hybrid surgical-radiotherapy approach has proven effective in the management of spinal metastases.

本研究旨在评估立体定向体部放射治疗（SBRT）与分离手术（SS）后三维适形放疗（3D - CRT）相比的疗效和安全性，重点关注转移性硬膜外脊髓压迫患者的局部疾病控制（LC）和总生存期（OS）。已证实SS联合SBRT与3D - CRT相比，可带来更优的OS和LC结局。虽然内脏转移的存在仍是关键的预后因素，但这种手术 - 放疗联合治疗方法已被证明在脊柱转移瘤的治疗中有效。

REF: Bevacqua G, Grespi V, Becattini E, Ottaviani MM, Trippa F, Conti C. The Role of Separation Surgery and Advanced Radiotherapy in Metastatic Epidural Spinal Cord Compression: A Single-Center Retrospective Study Comparing Stereotactic Body Radiation Therapy and 3D-Conformal Radiotherapy. World Neurosurg. 2025;203:124491. doi:10.1016/j.wneu.2025.124491 PMID: 40975307

Cerebrospinal Fluid Refill Test

脑脊液再充盈试验

Cerebrospinal fluid (CSF) hypovolemia is often difficult to diagnose because reduced CSF pressure and radiographic findings are not consistently observed. To address this limitation, we developed the CSF refill test, a novel diagnostic procedure based on temporary CSF replenishment and evaluation of symptom improvement. This study reports preliminary and prospective results of this method. The CSF refill test is a promising diagnostic tool for CSF hypovolemia that directly demonstrates symptom improvement after CSF replenishment. It may aid in diagnosis, guide treatment decisions, and predict therapeutic response to epidural blood patch therapy.

脑脊液（CSF）容量不足通常难以诊断，因为脑脊液压力降低和影像学表现并非总是能被观察到。为解决这一局限性，我们开发了脑脊液补充试验，这是一种基于临时补充脑脊液并评估症状改善情况的新型诊断方法。本研究报告了该方法的初步前瞻性结果。脑脊液补充试验是一种很有前景的诊断脑脊液容量不足的工具，它能直接证明补充脑脊液后症状得到改善。该试验可能有助于诊断，指导治疗决策，并预测硬膜外血补丁疗法的治疗反应。

REF: Nakai E, Fukuda H, Ueba T. Cerebrospinal Fluid Refill Test. World Neurosurg. 2025;203:124456. doi:10.1016/j.wneu.2025.124456 PMID: 40930340

Surgical Strategy for Superior Cerebellar Peduncle Lesions: Utility of the Subtemporal Transtentorial Approach

小脑上脚病变的手术策略：颞下经幕入路的应用价值

Tumors involving the superior cerebellar peduncle (SCP) are rare and pose considerable surgical challenges due to their deep and complex location. While the supracerebellar infratentorial approach has been the most frequently described strategy, it may be insufficient for lesions extending along the entire SCP. We present 2 cases of SCP tumors to highlight the utility of the subtemporal transtentorial approach. The subtemporal transtentorial approach offers a direct and linear trajectory to lesions extending along the entire SCP, allowing substantial resection while minimizing functional morbidity. Although experience remains limited, this approach should be considered for surgical access to the SCP.

累及小脑上脚（SCP）的肿瘤较为罕见，因其位置深且解剖结构复杂，给手术带来了相当大的挑战。虽然小脑上幕下入路是最常被提及的手术策略，但对于累及整个小脑上脚的病变而言，该入路可能并不充分。我们报告2例小脑上脚肿瘤病例，以凸显颞下经幕入路的实用性。颞下经幕入路为累及整个小脑上脚的病变提供了直接且直线的手术路径，在实现肿瘤大部分切除的同时，可将功能损伤降至最低。尽管目前该入路的应用经验有限，但在对小脑上脚病变进行手术时应考虑采用此入路。

REF: Imai R, Kamamoto D, Katayama M, et al. Surgical Strategy for Superior Cerebellar Peduncle Lesions: Utility of the Subtemporal Transtentorial Approach. World Neurosurg. 2025;203:124467. doi:10.1016/j.wneu.2025.124467 PMID: 40946786

Endoscopic Transcortical Tubular-Based Resection of a Third Ventricle Colloid Cyst: Two-Dimensional Operative Video

经皮质内镜下管状入路切除第三脑室胶样囊肿：二维手术视频

We present a case of third ventricle colloid cyst surgical resection using a tubular-based endoscopic transcortical approach. Third ventricle colloid are rare benign lesions typically found in the anterolateral part of the third ventricle, close to the foramen of Monro.1 Several surgical approaches have been employed for their management.2-4 Tubular retractors have been introduced in the neurosurgical practice for their ability to minimize retraction-related injury by distributing retraction forces radially.5-7 A 35-year-old male with a history of multiple sclerosis presented with severe headache and dizziness. Neuroimaging revealed the presence of left ventricular enlargement. Lesion exhibited a homogeneously high magnetic resonance imaging T2 weighted/T2 weighted fluid attenuated inversion recovery signal with and peripheral enhancement indicative of a colloid cyst. Colloid cyst localized in zone I of the Beaumont classification. A left small frontal craniotomy was performed. A 17-mm diameter ViewSite Brain Access System (Vycor Medical Inc., Boca Raton, Florida, USA) tubular retractor was guided into the left lateral ventricle under neuronavigation. Following controlled decompression of the mucinous content, the cyst capsule was progressively mobilized from critical neurovascular structures and removed. Free communication of the ventricular system was confirmed; therefore, no further maneuver was necessary. No postoperative complications were observed during the postoperative course. Postoperative magnetic resonance imaging on first month confirmed the gross total resection and resolution of hydrocephalus. The endoscopic transcortical tubular-based approach is an effective and safe method for treating colloid cysts. This approach offers the advantages of minimal invasiveness, optimal visualization, and reduced tissue manipulation, establishing a valid method in the management of colloid cysts in the third ventricle.

我们报告了一例采用基于管状器械的经皮质内镜入路切除第三脑室胶样囊肿的病例。第三脑室胶样囊肿是罕见的良性病变，通常位于第三脑室前外侧，靠近室间孔。已有多种手术入路用于处理此类病变。管状牵开器已应用于神经外科手术，因其能够通过径向分散牵拉力，最大限度减少与牵拉相关的损伤。一名有多发性硬化病史的35岁男性，出现严重头痛和头晕症状。神经影像学检查显示左心室扩大。病变在磁共振成像T2加权/T2加权液体衰减反转恢复序列上呈现均匀高信号，且有周边强化，提示为胶样囊肿。胶样囊肿位于博蒙特分类的I区。进行了左侧小额叶开颅手术。在神经导航引导下，将直径17毫米的ViewSite Brain Access System（美国佛罗里达州博卡拉顿市Vycor Medical公司）管状牵开器置入左侧侧脑室。在对黏液样内容物进行控制性减压后，逐步将囊肿包膜从关键神经血管结构上分离并切除。确认脑室系统实现了自由相通，因此无需进一步操作。术后未观察到并发症。术后第一个月的磁共振成像证实囊肿全切除，脑积水得到缓解。基于管状器械的经皮质内镜入路是治疗胶样囊肿的一种安全有效的方法。该入路具有微创、视野良好和组织操作少等优点，是处理第三脑室胶样囊肿的一种有效方法。

REF: Bove I, Berardinelli J, Somma T, Solari D, Esposito F, Cavallo LM. Endoscopic Transcortical Tubular-Based Resection of a Third Ventricle Colloid Cyst: Two-Dimensional Operative Video. World Neurosurg. 2025;203:124436. doi:10.1016/j.wneu.2025.124436 PMID: 40915626