Long-term follow-up – Neurosurgery Blog

05/08/202504/08/2025

Long-term results of cervical disc arthroplasty: a single-center retrospective study with a minimum 10-year follow-up

J Neurosurg Spine 43:195–204, 2025

This 10-year retrospective study found that cervical disc arthroplasty (CDA) provides sustained clinical improvement and preserves segmental mobility, with the Bryan disc maintaining greater range of motion than the Prestige LP. However, high rates of heterotopic ossification (69.2%) and adjacent segment degeneration (55.4%) were observed.

• Retrospective single-center study of 74 patients (91 levels) undergoing Bryan or Prestige LP cervical disc arthroplasty (CDA) between 2004–2013, with minimum 10-year follow-up.

• Significant long-term improvement in clinical outcomes (JOA, NDI, VAS) maintained at 10 years postoperatively.

• No significant clinical outcome differences between Bryan and Prestige LP groups at any follow-up point.

• Bryan disc group had significantly higher global and segmental range of motion (ROM) than Prestige LP group at 10 years.

• High rates of radiological complications: heterotopic ossification (HO) in 69.2% (29.7% ROM-limiting), adjacent segment degeneration (ASD) in 55.4%, segmental kyphosis in 11% overall.

• No patients required reoperation during follow-up.

• Older age was a significant risk factor for ASD; no significant risk factors identified for HO.

• CDA provides satisfactory long-term clinical outcomes and preserves segmental mobility, but HO and ASD are common and require ongoing attention

06/09/202405/09/2024

Influence of the sagittal spinal profile type on the long-term outcome of patients with symptomatic lumbar spinal stenosis after microsurgical decompression

J Neurosurg Spine 41:353–359, 2024

Microsurgical decompression for patients with symptomatic lumbar spinal stenosis (LSS) has demonstrated long-term improvement concerning pain and function. Nonetheless, a considerable proportion of these patients do not experience satisfactory alleviation of symptoms. Previous studies have not found a direct influence of single sagittal parameters on patient outcomes. However, recent research indicates that a composite of parameters, presented in specific sagittal profile types (SPTs) that were defined by Roussouly and colleagues, may affect these outcomes. This study aims to investigate the impact of SPT on long-term outcomes of patients with LSS following microsurgical decompression.

METHODS This study is a prospective clinical observation. Patients with symptomatic LSS, who underwent microsurgical treatment and had long-term follow-up data for at least 36 months, were included. Patients with spinal deformity, fractures, or significant instability were excluded. Outcomes were measured using the numeric rating scale for pain, 36-Item Short Form Health Survey for quality of life, walking distance, Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Odom’s criteria. SPT was determined in blinded fashion by using preoperative long standing radiographs.

RESULTS The initial population of this observational study consisted of 128 patients, with long-term results available for 87 individuals, including 24 patients with SPT1, 20 with SPT2, 27 with SPT3, and 16 with SPT4. The average age was 70 years, with a slight male majority (56.3%) and a mean BMI of 27.9 kg/m 2 . After a median follow-up of 48 months, all groups showed significant improvement in walking distance, leg pain, and disability. Overall, 75% reported satisfaction with the surgery. However, patients with SPT1, which is characterized by low sacral slope and specific spinal curvatures, experienced significantly less improvement in back pain (p = 0.018) and related disability (p = 0.030), and lower satisfaction compared to other SPT groups (p = 0.008).

CONCLUSIONS The sagittal spinal type is influencing the long-term outcome of patients suffering from symptomatic LSS. Patients with a combination of a flat sacral slope and a low overall lumbar lordosis with a high lordosis in the lower lumbar spine (i.e., spinal SPT1) showed worse outcome concerning back pain and had decreased satisfaction with surgery than comparable subjects from other SPT groups. Consequently, the authors recommend the assessment of sagittal spinal types in patients diagnosed with symptomatic spinal stenosis prior to decompression surgery. Inclusion of SPT in the preoperative consultation process can provide valuable insights, potentially guiding practitioners to more tailored patient counseling.

10/07/201909/07/2019

Long-Term Reliability of Neuroendoscopic Aqueductoplasty in Idiopathic Aqueductal Stenosis-Related Hydrocephalus

Neurosurgery. Volume 85. 2019: 91–95

During the 1990s, endoscopic aqueductoplasty (AP) was considered to be a valuable alternative to endoscopic third ventriculostomy (ETV) in treating hydrocephalus related to idiopathic aqueductal stenosis (iAS), with promising short-term outcomes.

OBJECTIVE: To evaluate the long-term outcome of AP in the treatment of iAS.

METHODS: Long-term follow-up clinical examinations and magnetic resonance (MR) imaging were performed for patients treated by an AP for iAS in our department.

RESULTS: Twenty patients (14 female, 6 male, mean age 41.7 yr, range 0.5-67 yr) were treated between 1996 and 2002. Two patients were lost to long-term follow-up. One patient died 6 mo after AP, but death was not related to the procedure. The mean follow-up for the remaining 17 patients was 120 mo. Clinically relevant aqueductal reclosure was observed in 11/17 patients after a mean follow-up of 53.4 mo. These 11 patients underwent ETV, which has been successful during further follow-up. Four of the six remaining patients presented with no clinical symptoms, although aqueductal restenosis was observed on MR imaging. Thus, the overall failure rate of AP was 88.2%. The failures were homogeneously distributed over the entire follow-up period.

CONCLUSION: AP has a high risk of failure during long-term follow-up and is not recom- mended as the first choice of treatment in hydrocephalus caused by iAS. ETV should be done instead. AP may be reserved for a limited number of patients in whom ETV is not feasible but should be combined with stenting to avoid reclosure of the aqueduct.

28/12/201828/12/2018

Long-term outcomes of coil embolization of unruptured intracranial aneurysms

J Neurosurg 129:1492–1498, 2018

Long-term follow-up results of the treatment of unruptured intracranial aneurysms (UIAs) by means of coil embolization remain unclear. The aim of this study was to analyze the frequency of rupture, retreatment, stroke, and death in patients with coiled UIAs who were followed for up to 20 years at multiple stroke centers.

METHODS The authors retrospectively analyzed data from cases in which patients underwent coil embolization between 1995 and 2004 at 4 stroke centers. In collecting the late (≥ 1 year) follow-up data, postal questionnaires were used to assess whether patients had experienced rupture or retreatment of a coiled aneurysm or any stroke or had died.

RESULTS Overall, 184 patients with 188 UIAs were included. The median follow-up period was 12 years (interquartile range 11–13 years, maximum 20 years). A total of 152 UIAs (81%) were followed for more than 10 years. The incidence of rupture was 2 in 2122 aneurysm-years (annual rupture rate 0.09%). Nine of the 188 patients with coiled UIAs (4.8%) underwent additional treatment. In 5 of these 9 cases, the first retreatment was performed more than 5 years after the initial treatment. Large aneurysms were significantly more likely to require retreatment. Nine strokes occurred over the 2122 aneurysm-years. Seventeen patients died in this cohort.

CONCLUSIONS This study demonstrates a low risk of rupture of coiled UIAs with long-term follow-up periods of up to 20 years. This suggests that coiling of UIAs could prevent rupture for a long period of time. However, large aneurysms might need to be followed for a longer time.

25/07/201825/07/2018

Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in PatientsWith Refractory Anorexia Nervosa

Neurosurgery 83:86–92, 2018

Anorexia nervosa (AN) is one of the most challenging psychiatric disorders to treat. The poor clinical outcomes warrant novel treatments for AN, especially in severe and persistent cases.

OBJECTIVE: To explore the feasibility of magnetic resonance imaging-guided bilateral anterior capsulotomy in the treatment of refractory AN.

METHODS: Seventy-four patients diagnosed with refractory AN who underwent capsulotomy completed this 3-yr follow-up study. Outcomesincluded body mass index (BMI) and results froma series of psychiatric scales (for obsessive, depressive, and anxious symptoms) that were implemented at baseline (presurgery), and 1 mo, 1 yr, and 3 yr after surgery.

RESULTS: Compared to presurgical levels, BMI increased significantly at 1-yr and 3-yr follow-ups. Compared to presurgery scores, psychiatric scale scores were significantly improved at 1-mo postsurgery, and continued to remain low at the 1-yr and 3-yr follow-ups. In addition, Mini-Mental State Examination (MMSE) scores were in the normal range during the long-term follow-up. The most common short-term side effects included urinary incontinence (n = 7), sleep disorders (n = 8), and fatigue (n = 6). Longterm complications included disinhibition (n = 6), memory loss (n = 3), and lethargy (n = 4). No patient in this study experienced death or disability.

CONCLUSION: Capsulotomy enabled patients with refractory AN to normalize their weight, especially those in life-threatening conditions. While it appears to be an acceptable life-saving treatment, it is indicated only when fulfilling strict criteria given its complications and irreversibility.

18/06/201820/04/2020

Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion With an Autologous Iliac Crest Graft: A Magnetic Resonance Imaging Study of 59 Patients With a Mean Follow-up of 27 Years

Neurosurgery, 82, 6, 799–807, 2018

Anterior cervical decompression and fusion (ACDF) is a widely accepted surgical technique for the treatment of degenerative disc disease. ACDF is associated with adjacent segment degeneration (ASD).
OBJECTIVE: To assess whether physiological aging of the spine would overcome ASD by comparing adjacent to adjoining segments more than 18 yr after ACDF.
METHODS: Magnetic resonance imaging of 59 (36 male, 23 female) patients who underwent ACDF was performed to assess degeneration. The mean follow-up was 27 yr (18-45 yr). Besides measuring the disc height, a 5-step grading system (segmental degeneration index [SDI]) including disc signal intensity, anterior and posterior disc protrusion, narrowing of the disc space, and foraminal stenosis was used to assess the grade of adjacent and adjoining segments.
RESULTS: The SDI of cranial and caudal adjacent segments was significantly higher compared to adjoining segments (P < .001). The disc height of cranial and caudal adjacent segments was significantly lower compared to adjoining segments (P < .001, P < .01). The SDI of adjacent segments in patients with repeat cervical procedure was significantly higher than in patients without repeat procedure (P = .02, P = .01). The disc height of the cranial adjacent segments in patients with repeat procedure was significantly lower than in patients without repeat procedure (P = .01).
CONCLUSION: The physiological aging of the cervical spine does not overcome ASD. The disc height and the SDI in adjacent segment are significantly worse compared to adjoining segments. Patients who underwent repeat procedure had even worse findings of disc height and SDI.

30/03/201028/03/2010

Gamma Knife Surgery of Meningiomas Involving the Cavernous Sinus: Long-term Follow-up of 100 Patients

Neurosurgery 66:661-669, 2010.DOI: 10.1227/01. NEU.0000366112.04015.E2

Resection of meningiomas involving the cavernous sinus often is incomplete and associated with considerable morbidity. As a result, an increasing number of patients with such tumors have been treated with gamma knife surgery (GKS). However, few studies have investigated the long-term outcome for this group of patients.

METHODS: 100 patients (23 male/77 female) with meningiomas involving the cavernous sinus received GKS at the Department of Neurosurgery at Haukeland University Hospital, Bergen, Norway, between November 1988 and July 2006. They were followed for a mean of 82.0 (range, 0–243) months. Only 2 patients were lost to long-term follow-up. Sixty patients underwent craniotomy before radiosurgery, whereas radiosurgery was the primary treatment for 40 patients.

RESULTS: Tumor growth control was achieved in 84.0% of patients. Twelve patients required re-treatment: craniotomy (7), radiosurgery (1), or both (4). Three out of 5 patients with repeated radiosurgery demonstrated secondary tumor growth control. Excluding atypical meningiomas, the growth control rate was 90.4%. The 1-, 5-, and 10-year actuarial tumor growth control rates are 98.9%, 94.2%, and 91.6%, respectively. Treatment failure was preceded by clinical symptoms in 14 of 15 patients. Most tumor growths appeared within 2.5 years. Only one third grew later (range, 6–20 yr). The complication rate was 6.0%: optic neuropathy (2), pituitary dysfunction (3), worsening of diplopia (1), and radiation edema (1). Mortality was 0. At last follow-up, 88.0% were able to live independent lives.

CONCLUSION: GKS gives long-term growth control and has a low complication rate. Most tumor growths manifest within 3 years following treatment. However, some appear late, emphasizing the need for long-term follow-up.

17/11/200915/11/2009

Optimal treatment strategy for craniopharyngiomas based on long-term functional outcomes of recent and past treatment modalities

Neurosurg Rev. DOI 10.1007/s10143-009-0220-6

Although many authors have described treatment strategies for craniopharyngiomas, the optimal treatment of craniopharyngiomas remains controversial. This study aimed to define an adequate surgical strategy for craniopharyngiomas by reviewing the long-term functional performance of patients treated by current and past treatment modalities. Fifty-five patients with longer than

5 years of follow-up were selected for the present long-term study. The duration of follow-up ranged from 5.5 to 33 years (median, 14.8 years). There were 28 adult patients (14 males; median age, 44.4 years) and 27 children younger than 16 years of age (15 males; median age, 8.1 years). The patients were divided into the following treatment groups: single surgery (group A; n=14), multiple surgeries (group B; n=8), surgery or surgeries followed by radiotherapy (group C; n=23), surgery or surgeries (partial removal) followed by radiotherapy + additional treatments (multiple surgeries and/or re-irradiation; group D; n=10). In addition to the routine assessments of neurological, endocrine, and visual outcomes, the level of daily functioning was analyzed using the Karnofsky Performance Scale (KPS). Statistical analysis of relationship between KPS score and treatment mode demonstrated that group D had a significantly lower KPS score (F=5.82, p=0.0017). Furthermore, mortality, cognitive function, and visual function were significantly better in groups A, B, and C than in group D. Multiple regression analysis demonstrated that cognitive dysfunction, visual disturbance, and treatment mode were independent covariates that significantly affected postoperative

KPS score. Adequate primary treatment for craniopharyngiomas is important to avoid subsequent multiple treatments. Craniopharyngiomas should be removed surgically as far as possible but without further deteriorating cognitive and visual functions, either as total resection or subtotal resection with a small remnant that is controllable by radiation therapy.

Tag: Long-term follow-up

Long-term results of cervical disc arthroplasty: a single-center retrospective study with a minimum 10-year follow-up

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Influence of the sagittal spinal profile type on the long-term outcome of patients with symptomatic lumbar spinal stenosis after microsurgical decompression

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Long-Term Reliability of Neuroendoscopic Aqueductoplasty in Idiopathic Aqueductal Stenosis-Related Hydrocephalus

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Long-term outcomes of coil embolization of unruptured intracranial aneurysms

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Long-Term Follow-up Study of MRI-Guided Bilateral Anterior Capsulotomy in PatientsWith Refractory Anorexia Nervosa

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Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion With an Autologous Iliac Crest Graft: A Magnetic Resonance Imaging Study of 59 Patients With a Mean Follow-up of 27 Years

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Gamma Knife Surgery of Meningiomas Involving the Cavernous Sinus: Long-term Follow-up of 100 Patients

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Optimal treatment strategy for craniopharyngiomas based on long-term functional outcomes of recent and past treatment modalities

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