Radiofrequency Versus Percutaneous Balloon Compression for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis

射频治疗与经皮球囊压迫治疗三叉神经痛的系统评价和荟萃分析

Trigeminal neuralgia (TN) is a severe neuropathic pain disorder that may necessitate surgical intervention when medical therapy fails. Among minimally invasive procedures, radiofrequency (RF) lesioning and percutaneous balloon compression (PBC) are most widely used; however, their relative efficacy and safety remain controversial. This systematic review and meta-analysis included only double-arm comparative studies that directly evaluated RF and PBC outcomes in TN. Based on pooled superiority analyses, RF and PBC showed broadly comparable outcomes for several endpoints; however, these findings should not be interpreted as formal equivalence or non-inferiority.

三叉神经痛（TN）是一种严重的神经病理性疼痛疾病，当药物治疗失败时可能需要手术干预。在微创手术中，射频（RF）毁损术和经皮球囊压迫术（PBC）应用最为广泛；然而，它们的相对有效性和安全性仍存在争议。本系统评价和荟萃分析仅纳入直接评估TN患者接受RF和PBC治疗结局的双臂对照研究。基于汇总优势分析，RF和PBC在多个终点指标上的结局大致相当；然而，这些结果不应被解读为正式的等效性或非劣效性。

REF: Hajikarimloo B, Mohammadzadeh I, Mortezaei A, Habibi MA. Radiofrequency Versus Percutaneous Balloon Compression for Trigeminal Neuralgia: A Systematic Review and Meta-Analysis. World Neurosurg. 2026;208:124846. doi:10.1016/j.wneu.2026.124846 PMID: 41655636

Antiplatelet and Anticoagulation Use and Outcomes Following Chronic Subdural Hematoma Drainage: Systematic Review and Meta-analysis

慢性硬膜下血肿引流术后抗血小板和抗凝药物的使用及结局：系统评价与荟萃分析

Chronic subdural hematoma (CSDH) is a common neurosurgical condition. A significant percentage of CSDH patients are on antiplatelet or anticoagulation therapy at baseline. Despite this, the impact of preoperative antiplatelet and anticoagulation therapy on outcomes following CSDH evacuation, specifically the risk of recurrence and thromboembolic events, remain unclear. Clinicians need to weigh the risk of hemorrhage against thromboembolism when deciding when managing antithrombotic therapy for patients undergoing evacuation of CSDH.

慢性硬膜下血肿（CSDH）是一种常见的神经外科疾病。相当比例的CSDH患者在基线时正在接受抗血小板或抗凝治疗。尽管如此，术前抗血小板和抗凝治疗对CSDH清除术后预后的影响，特别是复发风险和血栓栓塞事件的风险，仍不清楚。临床医生在为接受CSDH清除术的患者管理抗栓治疗时，需要权衡出血风险与血栓栓塞风险。

REF: Liu E, Tilbury N, Morin T, et al. Antiplatelet and Anticoagulation Use and Outcomes Following Chronic Subdural Hematoma Drainage: Systematic Review and Meta-analysis. World Neurosurg. 2026;208:124873. doi:10.1016/j.wneu.2026.124873 PMID: 41707892

Neuropsychological Profile of Normal Pressure Hydrocephalus: A Systematic Review of Cognitive Trajectories and Evidence-Based Assessment Tools for Surgical Management

正常压力脑积水的神经心理学特征：认知轨迹的系统评价及基于证据的手术管理评估工具

Cognitive impairment is a key yet understudied component of normal pressure hydrocephalus (NPH). Although gait and radiological markers are routinely assessed, neuropsychological outcomes remain inconsistently reported, and no standardized cognitive battery exists for evaluating patients before and after cerebrospinal fluid shunt. This systematic review synthesizes available evidence on the cognitive trajectories of adults with NPH and identifies the neuropsychological tests that are most sensitive and clinically informative for monitoring outcomes following ventriculo-peritoneal and lumbo-peritoneal shunts. Cognitive recovery after shunt in NPH follows a predominantly fronto-subcortical pattern, with the greatest improvements occurring within the first postoperative year. MMSE, TMT-A, TMT-B, and Digit Span represent the most reliable and informative neuropsychological tools for preoperative and postoperative evaluation and should constitute the core of a standardized NPH-specific cognitive battery. Establishing uniform testing protocols and improving methodological consistency across studies will enhance diagnostic accuracy, surgical decision-making, and long-term monitoring of this treatable condition.

认知障碍是正常压力脑积水（NPH）的一个关键但研究不足的组成部分。尽管步态和影像学标志物通常会被评估，但神经心理学结局的报告仍不一致，且目前尚无用于评估脑脊液分流前后患者的标准化认知测试组合。本系统评价综合了有关成人NPH认知轨迹的现有证据，并确定了对监测脑室 - 腹腔分流术和腰 - 腹腔分流术后结局最敏感且具有临床信息价值的神经心理学测试。NPH患者分流术后的认知恢复主要呈额叶 - 皮质下模式，最大改善出现在术后第一年。简易精神状态检查表（MMSE）、连线测验A（TMT - A）、连线测验B（TMT - B）和数字广度测验是术前和术后评估最可靠且信息丰富的神经心理学工具，应构成标准化NPH特异性认知测试组合的核心。建立统一的测试方案并提高各研究间的方法学一致性，将提高这种可治疗疾病的诊断准确性、手术决策水平和长期监测效果。

REF: Scalia G, Pitoia R, Passarello L, et al. Neuropsychological Profile of Normal Pressure Hydrocephalus: A Systematic Review of Cognitive Trajectories and Evidence-Based Assessment Tools for Surgical Management. World Neurosurg. 2026;208:124868. doi:10.1016/j.wneu.2026.124868 PMID: 41698503

Improved Hybrid Surgery for Chronic Carotid Artery Occlusion: A Technical Note

慢性颈动脉闭塞改良杂交手术：技术报告

An optimal surgical technique of hybrid surgery for patients with chronic total occlusion remains unclear. We report an improved hybrid strategy utilizing dual arterial sheath placement (carotid and femoral) to enhance procedural success while mitigating risks such as embolism and dissection. The improved hybrid technique combining endarterectomy with dual-sheath intervention demonstrates feasibility and safety in treating chronic carotid occlusion, though larger studies are needed to confirm its efficacy.

对于慢性完全闭塞病变患者而言，杂交手术的最佳术式仍不明确。我们报告了一种改良的杂交策略，即采用双动脉鞘置入（颈动脉和股动脉），以提高手术成功率，同时降低栓塞和夹层等风险。这种将内膜切除术与双鞘介入相结合的改良杂交技术在治疗慢性颈动脉闭塞方面显示出可行性和安全性，不过仍需开展更大规模的研究来证实其疗效。

REF: Yuan HW, Sun Y, Wang XH. Improved Hybrid Surgery for Chronic Carotid Artery Occlusion: A Technical Note. World Neurosurg. 2026;208:124847. doi:10.1016/j.wneu.2026.124847 PMID: 41655637

A Modified Direct Suction Decompression Strategy for Complex Middle Cerebral Artery Bifurcation Aneurysms in the Endovascular Era: Technical Note and Literature Review

血管内治疗时代复杂大脑中动脉分叉部动脉瘤的改良直接抽吸减压策略：技术报告与文献综述

Direct suction decompression facilitates the clipping of complex middle cerebral artery (MCA) bifurcation aneurysms; however, with conventional direct puncture, intermittent reperfusion is limited after dome puncture, and the setup can crowd the operative corridor. We report our initial experience with bypass-assisted stump isolation with controlled suction (BASICS), a modified technique. BASICS may mitigate the limitations of puncture-based suction decompression by enabling controlled and repeatable decompression and facilitating stepwise reconstructive clipping in selected complex MCA bifurcation aneurysms. When needed, conversion to a sidewall configuration may expand the multimodal options, including staged endovascular adjuncts. These potential advantages are hypothesis-generating, warranting further validation.

直接抽吸减压有助于夹闭复杂的大脑中动脉（MCA）分叉部动脉瘤；然而，采用传统的直接穿刺方法，瘤顶穿刺后间歇性再灌注受限，且操作装置可能会占据手术通道。我们报告了我们使用改良技术——旁路辅助残端隔离并可控抽吸（BASICS）的初步经验。BASICS技术可通过实现可控且可重复的减压，并有助于对部分复杂的MCA分叉部动脉瘤进行分步重建夹闭，从而减轻基于穿刺的抽吸减压的局限性。必要时，转换为侧壁构型可能会拓展多模式治疗方案，包括分期血管内辅助治疗。这些潜在优势只是提出了假设，需要进一步验证。

REF: Suzuki R, Takizawa K. A Modified Direct Suction Decompression Strategy for Complex Middle Cerebral Artery Bifurcation Aneurysms in the Endovascular Era: Technical Note and Literature Review. World Neurosurg. 2026;208:124849. doi:10.1016/j.wneu.2026.124849 PMID: 41687917

Prone Positioning in the Leksell G Frame for Posterior Fossa Stereotaxy in Young Children

小儿后颅窝立体定向手术中在莱克塞尔G型头架上采用俯卧位

Stereotactic interventions in the posterior fossa of children are rarely performed due to anatomical constraints, technical limitations, and lack of dedicated studies. Traditional stereotactic methods, including upside-down frame placement or intraoperative repositioning, present challenges such as increased procedural complexity, risk of pin dislodgement, and the need for manual coordinate calculations. This study evaluates a novel technique using prone positioning in the Leksell G frame for posterior fossa stereotactic procedures in pediatric patients. By modifying standard intraoperative workflows, this method allows for safe, precise, and cost-effective stereotactic interventions without additional hardware. Prone positioning in the Leksell G frame, with specific technical modifications, enables safe and accurate stereotactic posterior fossa procedures in pediatric patients. This approach eliminates the need for intraoperative repositioning and ensures seamless integration with widely available stereotactic planning software. By utilizing existing tools and refining workflow, this method provides a practical, cost-effective, and reproducible solution for extending stereotactic neurosurgery to the pediatric population.

由于解剖学限制、技术局限以及缺乏专门研究，儿童后颅窝的立体定向干预很少进行。传统的立体定向方法，包括倒置框架放置或术中重新定位，存在一些挑战，如增加手术操作复杂性、有针移位风险以及需要手动计算坐标等。本研究评估了一种在儿科患者后颅窝立体定向手术中使用莱克塞尔G型框架俯卧位的新技术。通过修改标准的术中工作流程，该方法无需额外硬件即可实现安全、精确且经济高效的立体定向干预。莱克塞尔G型框架下的俯卧位结合特定的技术改进，能让儿科患者安全准确地进行后颅窝立体定向手术。这种方法无需术中重新定位，并确保与广泛使用的立体定向规划软件无缝集成。通过利用现有工具并优化工作流程，该方法为将立体定向神经外科手术推广到儿科人群提供了一种实用、经济且可重复的解决方案。

REF: Kirchleitner SV. Prone Positioning in the Leksell G Frame for Posterior Fossa Stereotaxy in Young Children. World Neurosurg. 2026;208:124870. doi:10.1016/j.wneu.2026.124870 PMID: 41698502

A Fixed Left-Sided Surgeon Position in Unilateral Biportal Endoscopic Surgery for Lumbar Disc Herniation: A Technical Note with Variations According to Herniation Type

腰椎间盘突出症单侧双镜联合内镜手术中固定左侧手术医生站位：根据突出类型的技术要点及变化

Unilateral biportal endoscopy (UBE) is increasingly used for the treatment of lumbar disc herniation. In this bimanual technique, adapting surgeon positioning according to herniation laterality may negatively affect ergonomics and operating room workflow. The feasibility and clinical impact of a fixed surgeon-positioning strategy independent of herniation laterality remain insufficiently documented. Maintaining a constant left-sided surgeon position in UBE allows safe decompression across the full spectrum of lumbar disc herniation types without compromising surgical access or visualization.

单侧双镜联合内镜技术（UBE）越来越多地用于治疗腰椎间盘突出症。在这种双手操作技术中，根据突出侧别调整术者站位可能会对人体工程学和手术室工作流程产生不利影响。不考虑突出侧别的固定术者站位策略的可行性和临床影响仍缺乏充分记录。在UBE手术中保持术者恒定左侧站位，可在不影响手术入路或视野的情况下，对各种类型的腰椎间盘突出症进行安全减压。

REF: Sellier A, Lechanoine F, Lonjon G, et al. A Fixed Left-Sided Surgeon Position in Unilateral Biportal Endoscopic Surgery for Lumbar Disc Herniation: A Technical Note with Variations According to Herniation Type. World Neurosurg. 2026;208:124890. doi:10.1016/j.wneu.2026.124890 PMID: 41763355

Microsurgical Treatment of Ethmoidal Dural Arteriovenous Fistula

筛窦硬脑膜动静脉瘘的显微外科治疗

A 78-year-old male patient presented with an episode of confusion. Computed tomography angiography (CTA) revealed an abnormal collection of vessels in the basal frontal region, and diagnostic cerebral angiogram revealed an ethmoidal dural arteriovenous fistula (dAVF). dAVFs are rare intracranial vascular lesions, comprising approximately 2%-3% of all dAVFs.1-3These fistulas are primarily supplied by the ethmoidal branches of the ophthalmic artery.1-3A high-grade ethmoidal dural arteriovenous fistula characterized by cortical venous drainage or associated symptoms requires treatment.4Intervention is necessary due to the potential risk of intracranial hypertension or hemorrhage,4which could lead to serious neurological deficits.5Endovascular treatment of ethmoidal dural arteriovenous fistulas, while possible, could lead to blindness due to ethmoidal feeders branching from ophthalmic artery and risk of retrograde embolization.6Given the fistula's angioarchitecture and supply solely from ethmoidal branches, microsurgery was selected as the primary treatment to mitigate the risk of visual compromise. The patient underwent microsurgical treatment for dAVF disconnection. The surgical strategy involved subarachnoid dissection, identification of the main draining vein, identification of fistulous arteries, coagulation of the feeders, and disconnection of the main draining vein. The patient made an excellent recovery, and his confusion resolved. He was initially discharged to home on postoperative day 2 but returned due to left-sided weakness and a right convexity hygroma requiring single burr hole drainage. A 1-month follow-up in clinic revealed the patient was neurologically intact, and a CTA of the head revealed no residual fistula. At the 1-year follow-up, he was without neurological deficit. A follow-up CTA showed no evidence of recurrence. This video article aims to demonstrate the key microsurgical steps, anatomical landmarks, and the efficacy of open surgery as a primary treatment for these unique fistulas.

一名78岁男性患者出现了一次意识混乱发作。计算机断层血管造影（CTA）显示额叶底部区域有异常血管团，诊断性脑血管造影显示为筛窦硬脑膜动静脉瘘（dAVF）。硬脑膜动静脉瘘是罕见的颅内血管病变，约占所有硬脑膜动静脉瘘的2% - 3%。这些瘘主要由眼动脉的筛窦分支供血。高级别的筛窦硬脑膜动静脉瘘，其特征为皮质静脉引流或伴有相关症状，需要进行治疗。由于存在颅内高压或出血的潜在风险，干预是必要的，这可能导致严重的神经功能缺损。筛窦硬脑膜动静脉瘘的血管内治疗虽然可行，但由于筛窦供血支来自眼动脉，且有逆行栓塞的风险，可能导致失明。鉴于该瘘的血管结构以及仅由筛窦分支供血，选择显微外科手术作为主要治疗方法，以降低视力受损的风险。该患者接受了显微外科手术以切断硬脑膜动静脉瘘。手术策略包括蛛网膜下腔分离、识别主要引流静脉、识别瘘动脉、凝固供血支以及切断主要引流静脉。患者恢复良好，意识混乱症状消失。术后第2天患者最初出院回家，但因左侧肢体无力和右侧凸面积液需要单钻孔引流而返回医院。术后1个月的门诊随访显示患者神经功能正常，头部CTA显示无残余瘘。术后1年随访时，患者无神经功能缺损。随访CTA显示无复发迹象。本视频文章旨在展示这些独特瘘的关键显微外科手术步骤、解剖标志以及开放手术作为主要治疗方法的有效性。

REF: Hallan DR, Hong J, Church EW. Microsurgical Treatment of Ethmoidal Dural Arteriovenous Fistula. World Neurosurg. 2026;208:124845. doi:10.1016/j.wneu.2026.124845 PMID: 41654219

Exoscopic Resection of an Olfactory Groove Meningioma Through an Anterior Interhemispheric Approach

经前纵裂入路外视镜下切除嗅沟脑膜瘤

Olfactory groove meningiomas are challenging lesions due to their proximity to major vascular structures and frequent frontal lobe edema or hyperostosis. Various transcranial and endoscopic approaches have been described, each with specific advantages and limitations. We present the case of a 70-year-old woman with longstanding anosmia who recently developed apathy and irritability. An olfactory groove meningioma was resected through an anterior interhemispheric approach, chosen to minimize subfrontal parenchymal traction (Video 1). Exoscopic visualization provided excellent illumination and magnification throughout the procedure. The surgery was completed with a gross total resection, showing the feasibility and safety of this approach for selected cases.

嗅沟脑膜瘤是具有挑战性的病变，因为它们靠近主要血管结构，且常伴有额叶水肿或骨质增生。已经报道了多种经颅和内镜入路，每种入路都有其特定的优势和局限性。我们介绍了一名患有长期嗅觉丧失的70岁女性病例，她近期出现了淡漠和易怒症状。通过前半球间入路切除了嗅沟脑膜瘤，选择该入路是为了尽量减少额叶下实质的牵拉（视频1）。在整个手术过程中，外视镜可视化提供了出色的照明和放大效果。手术实现了肿瘤全切除，表明该入路在选择合适的病例时具有可行性和安全性。

REF: Somma T, Berardinelli J, Bove I, Cavallo LM. Exoscopic Resection of an Olfactory Groove Meningioma Through an Anterior Interhemispheric Approach. World Neurosurg. 2026;208:124886. doi:10.1016/j.wneu.2026.124886 PMID: 41724466