What's New with Intraneural Ganglion Cysts?

神经内腱鞘囊肿有哪些新进展？

Intraneural ganglion cysts (IGCs) are rare, mucin-filled lesions that develop within peripheral nerves, most commonly the common peroneal nerve arising from the superior tibiofibular joint. Their pathogenesis has been explained by the unified articular theory. Over the past two decades, new anatomic, imaging, and surgical insights have refined this theory and its clinical application and have been supported by historic perspectives. Current evidence supports the unified articular theory as the definitive explanation for all IGCs. Successful management requires articular branch disconnection and/or treatment of the joint source. Future work should focus on advanced imaging, standardized outcomes, and minimally invasive articular approaches.

神经内腱鞘囊肿（IGCs）是一种罕见的、充满黏液的病变，发生于周围神经内，最常累及源于上胫腓关节的腓总神经。其发病机制可用统一关节理论来解释。在过去的二十年里，新的解剖学、影像学和手术见解完善了这一理论及其临床应用，并且得到了历史观点的支持。目前的证据支持将统一关节理论作为所有神经内腱鞘囊肿的确定性解释。成功的治疗需要切断关节分支和/或处理关节源头。未来的工作应聚焦于先进的影像学检查、标准化的治疗结果评估以及微创关节入路。

REF: Texakalidis P, de Ruiter GCW, Amrami KK, Spinner RJ. What's New with Intraneural Ganglion Cysts?. World Neurosurg. 2026;206:124765. doi:10.1016/j.wneu.2025.124765 PMID: 41475455

Efficacy and Safety of Endovascular Recanalization for Non-acute Intracranial Arterial Occlusion: A Systematic Review and Meta-Analysis

血管内再通术治疗非急性颅内动脉闭塞的有效性和安全性：系统评价与荟萃分析

The clinical efficacy of endovascular recanalization in patients with non-acute intracranial arterial occlusion (NAICAO) remains controversial. In NAICAO, endovascular recanalization presents a good safety and efficacy. Endovascular recanalization could be another option for patients with NAICAO ineffective on medical treatment.

血管内再通术治疗非急性颅内动脉闭塞（NAICAO）患者的临床疗效仍存在争议。在NAICAO患者中，血管内再通术具有良好的安全性和有效性。对于药物治疗无效的NAICAO患者，血管内再通术可能是另一种选择。

REF: Chen X, Zhou T, Xiao C, et al. Efficacy and Safety of Endovascular Recanalization for Non-acute Intracranial Arterial Occlusion: A Systematic Review and Meta-Analysis. World Neurosurg. 2026;206:124770. doi:10.1016/j.wneu.2025.124770 PMID: 41475460

Circumferential Minimally Invasive Adult Spinal Deformity Surgery: A Systematic Review With Key Concepts and Technical Considerations

环形微创成人脊柱畸形手术：一项涵盖关键概念和技术考量的系统评价

While open techniques have historically dominated adult spinal deformity (ASD) surgery, minimally invasive (MIS) approaches have become ubiquitous in recent years due to advances in intraoperative guidance, spinal robotics, and planning software. Despite its promise, circumferential MIS (cMIS) for ASD remains uncertain in matching the appropriate correction of open surgery. This systematic review highlights core principles and techniques behind successful cMIS outcomes in ASD. CMIS for ASD is a safe and effective technique that achieves meaningful improvements in alignment and patient-reported outcomes while minimizing complications in appropriately selected patients.

虽然开放性手术技术在成人脊柱畸形（ASD）手术中一直占据主导地位，但近年来，由于术中导航、脊柱机器人技术和规划软件的进步，微创（MIS）手术方法已得到广泛应用。尽管前景良好，但全脊柱微创（cMIS）手术在实现与开放性手术相当的矫正效果方面仍存在不确定性。这篇系统综述重点介绍了成人脊柱畸形全脊柱微创手术成功实现良好治疗效果背后的核心原则和技术。对于经过适当筛选的患者，成人脊柱畸形全脊柱微创手术是一种安全有效的技术，能显著改善脊柱排列和患者报告的治疗结局，同时将并发症降至最低。

REF: Real M, Sigua LH, Allen MR, Brown NJ, Kim TY, Pham MH. Circumferential Minimally Invasive Adult Spinal Deformity Surgery: A Systematic Review With Key Concepts and Technical Considerations. World Neurosurg. 2026;206:124785. doi:10.1016/j.wneu.2025.124785 PMID: 41490617

Intracranial Candida Auris Infection: A Case Report and Scoping Review

颅内耳念珠菌感染：1例病例报告及范围综述

Candida auris (C. auris) is a multidrug-resistant yeast capable of causing invasive infections in both immunocompromised and immunocompetent hosts. While bloodstream and wound infections are well described, central nervous system (CNS) involvement remains rare and poorly characterized. We present a case of C. auris CNS infection and a scoping review of adult cases to identify trends in diagnosis and treatment. Key themes include 1) neurosurgical devices markedly increase CNS C. auris risk, 2) rapid diagnostics and susceptibility-guided therapy are imperative, 3) regimens targeting both systemic and CNS compartments may improve outcomes, and 4) device management is critical. Standardized protocols, multicenter registries, and pharmacokinetic studies are needed to guide treatment of this emerging, life-threatening infection.

耳念珠菌（C. auris）是一种多重耐药酵母，能够在免疫功能低下和免疫功能正常的宿主中引发侵袭性感染。虽然血流和伤口感染已有详细描述，但中枢神经系统（CNS）受累情况仍然罕见且特征描述不足。我们报告了一例耳念珠菌中枢神经系统感染病例，并对成人病例进行了范围综述，以确定诊断和治疗的趋势。关键要点包括：1）神经外科装置显著增加了中枢神经系统耳念珠菌感染的风险；2）快速诊断和基于药敏结果的治疗至关重要；3）针对全身和中枢神经系统的治疗方案可能改善预后；4）装置管理至关重要。需要制定标准化方案、建立多中心登记系统和开展药代动力学研究，以指导对这种新出现的、危及生命的感染的治疗。

REF: Jelkin GL, Heineman AL, Beckett HT, Goddard CM, Ngwenya LB. Intracranial Candida Auris Infection: A Case Report and Scoping Review. World Neurosurg. 2026;206:124775. doi:10.1016/j.wneu.2025.124775 PMID: 41485597

Stereotactic Radiosurgery for Facial Nerve Schwannoma: A Systematic Review and Meta-Analysis

面神经神经鞘瘤的立体定向放射外科治疗：系统评价与荟萃分析

Facial nerve schwannomas (FNS) are rare intracranial lesions that pose a therapeutic challenge due to their proximity to critical neurovascular anatomical structures. While microsurgical resection (MS) is linked to a significant risk of facial nerve dysfunction, stereotactic radiosurgery (SRS) is a non-invasive alternative that may reduce the potential damage to the facial nerve. This systematic review and meta-analysis aimed to assess the efficacy and safety of SRS in patients with FNS. SRS is an effective and safe option for managing patients with FNS, showing promising clinical and radiologic outcomes, especially in those with small-sized lesions or favorable FNF. Future studies should focus on directly comparing SRS and MS in large, prospective, multicenter trials.

面神经神经鞘瘤（FNS）是罕见的颅内病变，由于其毗邻重要的神经血管解剖结构，给治疗带来了挑战。虽然显微手术切除（MS）与面神经功能障碍的显著风险相关，但立体定向放射外科（SRS）是一种非侵入性的替代方法，可能会减少对面神经的潜在损伤。本系统评价和荟萃分析旨在评估SRS治疗FNS患者的有效性和安全性。SRS是治疗FNS患者的一种有效且安全的选择，显示出良好的临床和影像学结果，尤其适用于病灶较小或面神经功能良好的患者。未来的研究应聚焦于在大型、前瞻性、多中心试验中直接比较SRS和MS。

REF: Hajikarimloo B, Mohammadzadeh I, Mortezaei A, Habibi MA. Stereotactic Radiosurgery for Facial Nerve Schwannoma: A Systematic Review and Meta-Analysis. World Neurosurg. 2026;206:124756. doi:10.1016/j.wneu.2025.124756 PMID: 41478371

Tailored Callosotomy Guided by Neuronavigated Autofocus Microscope for Interhemispheric Transcallosal Approach to Intraventricular Lesions

神经导航自动聚焦显微镜引导下的定制胼胝体切开术用于经胼胝体半球间入路治疗脑室内病变

The interhemispheric transcallosal route (IHTCR) is often chosen to approach intraventricular lesions, despite being associated with specific morbidity, such as disconnection syndrome; thus, some key points include minimizing the size of callosotomy and possibly avoiding the incision of the middle/posterior third of the body of the corpus callosum that might be associated with severe morbidity. Despite this need, reports on the use of neuronavigation for a tailored IHTCR are scarce in the literature. This study describes the technical nuances of our neuronavigated autofocus microscope (NAM)-guided strategy and reports our results about the size of the callosotomy. Our NAM-guided strategy to a tailored IHTRC enables us to design a customized approach for the single patient, facilitating surgical procedures and achieving a small callosotomy size in relation to the dimensions of the tumor.

经半球间胼胝体入路（IHTCR）常被用于处理脑室内病变，尽管该入路与特定的并发症（如离断综合征）相关；因此，一些关键点包括尽量减小胼胝体切开的范围，并尽可能避免切开胼胝体体部的中后三分之一，因为这可能与严重的并发症相关。尽管有这样的需求，但文献中关于使用神经导航进行个性化经半球间胼胝体入路的报道却很少。本研究描述了我们采用神经导航自动聚焦显微镜（NAM）引导策略的技术细节，并报告了我们在胼胝体切开范围方面的结果。我们采用 NAM 引导的个性化经半球间胼胝体入路策略，能够为单个患者设计定制化的入路，便于手术操作，并能根据肿瘤大小实现较小的胼胝体切开范围。

REF: Campagnaro L, Bonaudo C, Enderage Don S, et al. Tailored Callosotomy Guided by Neuronavigated Autofocus Microscope for Interhemispheric Transcallosal Approach to Intraventricular Lesions. World Neurosurg. 2026;206:124755. doi:10.1016/j.wneu.2025.124755 PMID: 41456757

Treatment of Calcified Thoracic Disc Herniation by Percutaneous Spinal Endoscopy with Culvert Decompression

经皮脊柱内镜涵道减压治疗钙化性胸椎间盘突出症

To evaluate the surgical approach, clinical efficacy, and safety of percutaneous spinal endoscopic "culvert decompression" in treating calcified thoracic disc herniation (TDH). The culvert decompression technique adheres to a "from anterior to posterior, from outside to inside" principle. Sequential drilling of bone and disc tissue from the posterior vertebral body extends toward the anterior dural space near the midline. This stepwise decompression maximizes buffer space and minimizes dural irritation-particularly beneficial in cases with dural adhesions. Thus, this minimally invasive percutaneous spinal endoscopic method appears to be a safe and feasible option for calcified TDH.

评估经皮脊柱内镜“涵洞减压”治疗钙化性胸椎间盘突出症（TDH）的手术入路、临床疗效及安全性。涵洞减压技术遵循“由前向后、由外向内”的原则。从椎体后部依次钻磨骨质和椎间盘组织，向靠近中线的硬膜前间隙延伸。这种分步减压方式能最大程度增加缓冲空间，同时将对硬膜的刺激降至最低，尤其适用于存在硬膜粘连的病例。因此，这种经皮脊柱内镜微创方法似乎是治疗钙化性胸椎间盘突出症的一种安全可行的选择。

REF: Xiao D, Li Y, Sun N, Liu X, Li R, Sun T. Treatment of Calcified Thoracic Disc Herniation by Percutaneous Spinal Endoscopy with Culvert Decompression. World Neurosurg. 2026;206:124763. doi:10.1016/j.wneu.2025.124763 PMID: 41475457

Simultaneous Combined Multiportal Approach Using Transcranial and Endoscope-Assisted Midfacial Degloving Routes for Tumors with Skull Base and Extensive Sinonasal Involvement

经颅与内镜辅助面中部掀翻入路联合多入路同期治疗累及颅底和广泛鼻窦的肿瘤

For many years, in cases of excessively extensive tumors affecting the sinonasal region and the skull base-where the novel technique of a combination of transciliary supraorbital keyhole craniotomy and endoscopic endonasal approach would not have yielded satisfactory outcomes due to anatomic limitations-our gold standard technique was a combination of transfacial and tailored transcranial approaches. To reduce surgical invasiveness, complications, and undesirable aesthetic outcomes during the surgical treatment of tumors with extensive sinonasal and skull base involvement, the transfacial approach was left behind in favor of a combination of simultaneously applied tailored transcranial and endoscope-assisted midfacial degloving approaches. Our combined, simultaneous multiportal technique facilitates complete tumor resection with shortened operative times, low measures of intraoperative and postoperative complications, low mortality, and superb aesthetic outcomes.

多年来，对于累及鼻窦区域和颅底的肿瘤范围过大——由于解剖学限制，经睫上眶上锁孔开颅术与鼻内镜入路相结合的新技术无法取得满意效果——我们的金标准技术是经面入路和定制经颅入路相结合。为了在手术治疗广泛累及鼻窦和颅底的肿瘤时降低手术侵袭性、减少并发症并避免不理想的美学效果，经面入路逐渐被摒弃，转而采用同时应用的定制经颅入路和内镜辅助面中部掀翻入路相结合的方法。我们这种联合、同步的多入路技术有助于实现肿瘤的完全切除，缩短手术时间，降低术中和术后并发症的发生率，降低死亡率，并获得极佳的美学效果。

REF: Fischer-Szatmári T, Masood T, Senaobar Tahaei SA, Bella Z, Barzó P. Simultaneous Combined Multiportal Approach Using Transcranial and Endoscope-Assisted Midfacial Degloving Routes for Tumors with Skull Base and Extensive Sinonasal Involvement. World Neurosurg. 2026;206:124780. doi:10.1016/j.wneu.2025.124780 PMID: 41485596

Awake surgery for intrinsic cerebellar tumor involving the middle cerebellar peduncle

累及小脑小脚的小脑实质肿瘤 awake手术（此“awake surgery”需结合具体专业阐释，可能是“清醒开颅手术” ）

Originally introduced for epilepsy surgery,1awake brain surgery is now frequently used for resection of brain tumors.2-4In such cases, it allows for a more extensive and safer resection of supratentorial lesions in highly eloquent areas, such as motor, sensory, and language regions.5We present the case of a 22-year-old, right-handed woman who underwent awake surgery for an extraventricular cerebellar neurocytoma involving the middle cerebellar peduncle (Video 1). The patient experienced no neurological deterioration, and postoperative imaging revealed no residual tumor. Magnetic resonance imaging performed 6 months later revealed a tumor in the previous lesion bed at the level of the middle cerebellar peduncle. As complete resection is believed to provide significantly better control and survival compared with incomplete resection followed by radiotherapy, surgical removal of the residual tumor was recommended. Given that the lesion was located in a highly functional area, as indicated by her initial symptoms, the second procedure was done under awake craniotomy to allow for intraoperative clinical monitoring of the middle cerebellar peduncle to maximize tumor resection while minimizing the risk of neurological deficits such as intention tremor, dysmetria, and dysdiadochokinesia.6At 3-year follow-up, magnetic resonance imaging showed no recurrence. Tractography confirm a reduced number of highly functional ponto-cerebellar fibers, which could be clinically monitored during awake surgery.7Although previous surgical intervention in the posterior fossa is not a contraindication for awake surgery, within the posterior fossa, working in very close proximity to vital structures that control breathing or heart rate may be a significant limitation. Other potential contraindications8include intracranial hypertension, cerebellar swelling, very large or highly vascular tumor, and others. Awake surgery can be considered for patients with intrinsic posterior fossa tumors in selected cases, especially when highly functional areas such as the middle cerebellar peduncle are at risk.

最初，清醒开颅手术是为癫痫手术引入的，1如今它常被用于脑肿瘤切除。2 - 4在这类情况下，它能更广泛、更安全地切除位于运动、感觉和语言等重要功能区的幕上病变。5我们报告了一例22岁右利手女性患者的病例，她因累及小脑中间脚的室外型小脑神经细胞瘤接受了清醒开颅手术（视频1）。患者术后未出现神经功能恶化，术后影像学检查未发现残留肿瘤。6个月后进行的磁共振成像检查显示，在小脑中间脚水平的原病变部位出现了肿瘤。鉴于与不完全切除后进行放疗相比，完全切除被认为能显著更好地控制肿瘤并提高生存率，因此建议手术切除残留肿瘤。考虑到根据患者最初症状判断病变位于高功能区，第二次手术在清醒开颅下进行，以便在术中对小脑中间脚进行临床监测，从而在最大程度切除肿瘤的同时，将意向性震颤、辨距不良和轮替运动障碍等神经功能缺损风险降至最低。6在3年随访时，磁共振成像显示肿瘤未复发。纤维束成像证实高功能的脑桥 - 小脑纤维数量减少，这些纤维在清醒手术期间可进行临床监测。7尽管既往后颅窝手术并非清醒手术的禁忌证，但在后颅窝内靠近控制呼吸或心率的重要结构进行操作可能是一个重大限制。其他潜在禁忌证8包括颅内高压、小脑肿胀、非常大的或高血运的肿瘤等。在经过选择的病例中，特别是当小脑中间脚等高度功能区存在风险时，对于后颅窝原发性肿瘤患者可考虑采用清醒开颅手术。

REF: Bojanowski MW, Mrichi S, Martin T, et al. Awake surgery for intrinsic cerebellar tumor involving the middle cerebellar peduncle. World Neurosurg. 2026;206:124750. doi:10.1016/j.wneu.2025.124750 PMID: 41421654