Journal of neurosurgical sciences最新文献

{"title":"Postoperative pain management strategies in brain surgery.","authors":"Huseyin Erdem Ak","doi":"10.23736/S0390-5616.25.06611-1","DOIUrl":"10.23736/S0390-5616.25.06611-1","url":null,"abstract":"<p><p>The management of postoperative pain after brain surgery is challenging due to the vulnerability of neuroanatomic structures and differences in the perception of pain among different individuals. Pain management is essential for the patient's quick recovery. The main aim of the review is to assess the various pharmacological and non-pharmacological techniques for managing pain in patients after brain surgery, highlighting the potential benefits and safety. This is a focused narrative review of literature published between 2016 and 2024. A targeted search of major databases: PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Cochrane CENTRAL and Google Scholar was performed using terms for postoperative pain, craniotomy, neurosurgery, scalp block, multimodal analgesia, gabapentinoids, dexmedetomidine, cognitive behavioral therapy, Transcutaneous Electrical Nerve Stimulation and related concepts. The present review purposively selected randomized controlled trials, systematic reviews, meta-analyses and high-quality observational studies that evaluated analgesic strategies for major intracranial procedures. Non-English reports, narrative reviews lacking primary data, and studies with inadequate outcome reporting were excluded. Data synthesis is solely narrative and focused on comparative effectiveness and safety. The evidence supports opioid-sparing, multimodal strategies after major intracranial procedures. NSAIDs and acetaminophen show modest reductions in pain up to 12-24 hours. Local anesthetic scalp blocks and wound infiltration such as ropivacaine provide short-term benefit. Gabapentinoids reduce opioid consumption but increase dizziness and somnolence. Dexmedetomidine can delay rescue analgesia intraoperatively but is not consistently superior to alternatives. Non-pharmacologic approaches including, cognitive behavioral therapy, Transcutaneous Electrical Nerve Stimulation, Repetitive transcranial magnetic stimulation or, transcranial magnetic stimulation acupuncture show promise for longer-term or neuropathic symptoms, but evidence is limited and heterogeneous. Multimodal, opioid-sparing regimens, combining systemic non-opioid analgesics, targeted local or regional techniques, and selected adjuvants appear most effective for early postoperative pain after intracranial surgery. Non-pharmacologic therapies and neuromodulation may have adjunctive roles, but higher-quality comparative trials with standardized outcomes are needed to define optimal protocols and long-term effects.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 2","pages":"165-174"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes of ruptured cerebral arteriovenous malformations in the pediatric population.","authors":"Alis J Dicpinigaitis, Yu Guan, Julia Zhang, Richard Wang, Fawaz Al-Mufti","doi":"10.23736/S0390-5616.25.06643-3","DOIUrl":"10.23736/S0390-5616.25.06643-3","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"176-177"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sharpening skills: the role of virtual simulation in enhancing spinal neurosurgical proficiency.","authors":"Elio Mazzapicchi, Niccolò Innocenti, Francesco Restelli, Aurora Freguglia, Vittoria M Cojazzi, Davide Rossi, Mariarosa Gammone, Francesco Acerbi, Alessandro Perin, Francesco Dimeco, Francesco Costa","doi":"10.23736/S0390-5616.25.06572-5","DOIUrl":"10.23736/S0390-5616.25.06572-5","url":null,"abstract":"<p><strong>Background: </strong>Traditional neurosurgical training involves a steep learning curve. The introduction of advanced simulation technologies, like virtual reality, provides an alternative method for skill acquisition, allowing for repeated practice and objective assessment. This study focuses on evaluating the learning curve associated with lumbar pedicle Kirschner wire insertion using a virtual fluoroscopic simulator among neurosurgical residents.</p><p><strong>Methods: </strong>Eighteen neurosurgery residents and two interns participated in this study. Participants' initial skill levels were assessed through a questionnaire. Performance metrics, including insertion accuracy, time, and the number of virtual X-ray scans, were recorded across multiple attempts until a \"practical learning plateau\" was reached. Statistical analyses were conducted to model learning curves, assess the correlation between pre-training experience and performance.</p><p><strong>Results: </strong>The average number of attempts required to stabilize performance was 5.61. Learning rates varied, with some residents showing rapid improvement while others progressed more slowly. Higher accuracy in wire placement correlated with reduced usage on X-rays over time. However, experienced residents did not necessarily learn faster, indicating potential challenges in adapting to new simulation-based methods. Post-training feedback highlighted the simulator's utility in increasing confidence and skill levels, although some limitations in anatomical accuracy were noted.</p><p><strong>Conclusions: </strong>This study demonstrates the potential of virtual simulation to enhance neurosurgical training by providing a controlled environment for repeated practice and objective feedback. Simulation-based training can effectively complement traditional methods, though individualized approaches may be necessary to accommodate varying learning rates among residents. Further refinement of simulation tools and their integration into standard training curricula are recommended.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"98-107"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in diagnostic neurosurgery: promising results and need for rigorous validation.","authors":"Palwasha Asghar","doi":"10.23736/S0390-5616.26.06739-1","DOIUrl":"10.23736/S0390-5616.26.06739-1","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"175"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decompressive craniectomy for spontaneous supratentorial intracerebral hemorrhage: a systematic review and meta-analysis.","authors":"Renan M DA Costa, Ugo F Filho, Kíssia S Barbosa, André S Oliveira","doi":"10.23736/S0390-5616.25.06585-3","DOIUrl":"10.23736/S0390-5616.25.06585-3","url":null,"abstract":"<p><strong>Introduction: </strong>Spontaneous supratentorial intracerebral hemorrhage (SSICH) is a severe neurological condition associated with high morbidity and mortality, posing significant challenges to clinical management. Among the potential therapeutic strategies, decompressive craniectomy (DC) has been employed to reduce intracranial pressure and prevent secondary brain injury in various contexts, including traumatic brain injury (TBI) and spontaneous intracerebral hemorrhage (sICH). While its benefits are better established in some of these conditions, the specific role and efficacy of DC in the treatment of SSICH remain uncertain. In light of these uncertainties, we conducted a systematic review and meta-analysis to synthesize the available evidence and evaluate the impact of DC - alone or in combination with best medical treatment (BMT) - on clinical outcomes in patients with SSICH.</p><p><strong>Evidence acquisition: </strong>A systematic search was conducted in the PubMed, Embase, and Cochrane databases. Eligible studies included patients aged 18 to 75 years with SSICH, with the intervention being DC alone or DC combined with BMT, and the control group receiving BMT alone. Studies had to report the outcomes of interest, particularly the primary outcome of mortality. No specific time restrictions were applied, and only randomized controlled trials (RCTs) and observational studies were eligible. The risk of bias in the only RCT included was assessed using version 2 of the Cochrane Risk of Bias tool (RoB-2), while the five observational studies were evaluated using the Risk of Bias in Non-randomized Studies of Interventions tool (ROBINS-I).</p><p><strong>Evidence synthesis: </strong>A total of six studies were included, comprising 492 patients (224 treated with DC and 268 with BMT alone). Mortality at 30 days, 3 months, 6 months, and 12 months was lower in the intervention group (DC) compared to the control group (BMT alone). Subgroup analyses demonstrated statistical significance across all four timepoints. However, there were no statistically significant differences between groups regarding the incidence of overall infections, pneumonia and urinary tract infections.</p><p><strong>Conclusions: </strong>Our study concludes that DC reduces mortality in patients with SSICH compared to BMT, although the choice between these treatments does not appear to significantly affect the risk of pneumonia or urinary tract infections. Despite these findings, further studies - particularly RCTs - are needed to provide more robust evidence on this topic.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"56-65"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145708460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The \"FAST\" bypass philosophy: a framework for precision in superficial temporal artery to middle cerebral artery revascularization after 17,000 cases.","authors":"Bin Xu, Mohamed Helmy, Kristy Latour, Marco M Fontanella","doi":"10.23736/S0390-5616.25.06716-5","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06716-5","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 1","pages":"1-3"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genetic and biochemical profile of patients with severe traumatic brain injury: a prospective longitudinal observational tertiary care hospital-based study.","authors":"Manish Singh, Saurabh Singh, Alok Raghav, Praveen K Verma, Sunil Singh","doi":"10.23736/S0390-5616.25.06391-X","DOIUrl":"10.23736/S0390-5616.25.06391-X","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is one of the most common causes of admission to the emergency department of a hospital. Numerous blood and body-fluid based biomarkers have been identified to have a cost-effective and convenient potential of brain injury evaluation. The aim of the study is to evaluate the role of plasma resistin and its RETN gene polymorphism in TBI, and to correlate resistin and other biomarkers (NSE, MDA, SOD, GSH) with injury severity and in-hospital mortality.</p><p><strong>Methods: </strong>The eligible study participants (N.=140) having GCS between 15 to 3 were enrolled with TBI within 6 h hours after injury were dynamically monitored. Blood samples were extracted at different time interval (1st day of admission to 7th day). Plasma resistin, neuron specific enolase (NSE), malonaldehyde (MDA), superoxide dismutase (SOD) and GSH were measured at different time intervals using ELISA method. Later DNA was isolated using commercial kit and Rs7139228 RETN gene polymorphism was evaluated. Control healthy participants escorted the TBI patients were served as controls.</p><p><strong>Results: </strong>The levels of plasma resistin, NSE, MDA, and SOD at day 0 were found to be highest as 30.17±4.44, 21.53±4.17, 21.33±4.00, and 747.90±38.63 in TBI subjects were found significant highest compared to the levels at day 7^th. These markers tend to increase gradually from 0 h to 74 h of the hospital admission, the showed steep decrease pattern. GCS-based assessment score in TBI patients correlates with the plasma resistin (r<inf>s</inf>=0.081; P=0.339), neuron specific enolase (r<inf>s</inf>=0.028; P=0.737), malonaldehyde (r<inf>s</inf>=0.011; P=0.893), SOD (r<inf>s</inf>=0.167; P=0.047), GSH (r<inf>s</inf>=0.066; P=0.436). The RETN gene polymorphism showed no significant association with the TBI.</p><p><strong>Conclusions: </strong>It is concluded that blood biomarkers including antioxidants can be used for assessment of the outcome in patients with TBI.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 1","pages":"19-28"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal MGMT promoter methylation cut-off to predict better survival in glioblastoma patients undergoing gross-total resection.","authors":"Claudia Fanizzi, Petra Bintintan-Socaciu, Elena Pirola, Giorgio Fiore, Ilaria Carnicelli, Leonardo Tariciotti, Andrea Parlangeli, Elena Scagliotti, Silvia M Tabano, Gianluca Lopez, Stefano Ferrero, Stefania Navone, Laura Guarnaccia, Giovanni Marfia, Manuela Caroli, Marco Locatelli","doi":"10.23736/S0390-5616.25.06421-5","DOIUrl":"10.23736/S0390-5616.25.06421-5","url":null,"abstract":"<p><strong>Background: </strong>O6-Methylguanine-DNA methyltransferase (MGMT) promoter percentage of methylation in gliomas has been proved to be the most important predictive factor in temozolomide (TMZ) response. Nevertheless, an agreement about the cut-off to discriminate between a \"methylated\" and \"unmethylated\" status has not been reached yet. Many reports have analyzed the correlation between methylated status cut-off and survival, but they lacked sample homogeneity. Our aim was to calculate a clinical significant cut-off considering a homogenous group of patients.</p><p><strong>Methods: </strong>We retrospectively analyzed 96 patients who underwent a complete removal of glioblastoma in our Institution. All the patients underwent to radiation therapy plus concomitant TMZ and twelve cycles of adjuvant TMZ as described by Stupp. Receiver operating characteristic (ROC) curve analysis was performed and 21% was determined as the optimal cut-off.</p><p><strong>Results: </strong>The median OS was significantly higher in methylated patients compared to unmethylated ones (median 48 months vs. 22 months respectively 95% CI 30-42 vs. 15-19, P<0.001). No difference was observed for PFS. The multivariate analysis with Cox regression model identified MGMT methylation status as an independent predictive factor for OS (P<0.001).</p><p><strong>Conclusions: </strong>We confirmed the prognostic role of MGMT methylation status even in a highly selective group of patients with the best outcome. We calculated a cut-off of 21% to be highly predictable of survival.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"12-18"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Specificity of transcranial motor evoked potential monitoring was significantly improved by compound muscle action potential normalization after peripheral nerve stimulation.","authors":"Satoshi Tanaka, Ryosuke Tomio, Shinsuke Yoshida, Jiro Akimoto","doi":"10.23736/S0390-5616.25.06530-0","DOIUrl":"10.23736/S0390-5616.25.06530-0","url":null,"abstract":"<p><strong>Background: </strong>While intraoperative transcranial motor evoked potential (tcMEP) monitoring is widely used in spinal and brain surgery, it is sometimes not used because it can exhibit low specificity and give false-positive results.</p><p><strong>Methods: </strong>We studied 1833 muscles in 477 patients and 482 muscles in 206 patients without preoperative paralysis of manual muscle test of 2/5 or less in whom spinal and brain surgery, respectively, was performed under tcMEP monitoring. A receiver operating characteristic (ROC) analysis was used to calculate the cutoff point of amplitude relative values that cause postoperative paralysis, and the sensitivity and specificity of tcMEP monitoring with or without compound muscle action potential (CMAP) normalization after peripheral nerve stimulation.</p><p><strong>Results: </strong>In spinal surgery, the rate of tcMEP amplitude reduction resulting in postoperative paralysis was 54.0% without CMAP normalization and 73.9% under CMAP normalization, with a sensitivity of 92.3% with or without CMAP normalization, a specificity of 95.8% without CMAP normalization vs. 97.4% under CMAP normalization, and this difference was significant by Fisher's Exact Probability Test (two-tailed P=0.0133, one-tailed P=0.0067). In brain surgery, the percentage of tcMEP amplitude reduction resulting in postoperative paralysis was 55.0% without CMAP normalization vs. 68.1% under CMAP normalization, with a sensitivity of 87.0% without vs. 91.3% with CMAP normalization, and a specificity of 91.3% without vs. 95.6% with CMAP normalization, and these values were significantly different by Fisher's Exact Probability Test (two-tailed P=0.0225, one-tailed P=0.0112).</p><p><strong>Conclusions: </strong>CMAP normalization after peripheral nerve stimulation may significantly increase specificity in intraoperative tcMEP monitoring during spinal and brain surgery.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"29-35"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145377723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of membranectomy on chronic subdural hematoma outcomes: a meta-analysis and systematic review.","authors":"Donald E Ogolo, Okwunodulu Okwuoma, Kelechi Ndukuba, Obioma Akwada, Sunday Achebe, Sunday Nnama, Samuel Ohaegbulam","doi":"10.23736/S0390-5616.25.06599-3","DOIUrl":"10.23736/S0390-5616.25.06599-3","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic subdural hematoma (CSDH) is a common neurosurgical condition, yet the role of membranectomy in reducing recurrence remains controversial. This meta-analysis evaluates whether membranectomy improves outcomes compared to non-membranectomy techniques.</p><p><strong>Evidence acquisition: </strong>We systematically searched PubMed, Embase, and Cochrane for studies comparing membranectomy vs. non-membranectomy approaches (burr-hole, craniotomy, or drainage alone). Primary outcome was recurrence rate; secondary outcomes included functional recovery (GOS/mRS), complications, and operative time. Random-effects models were used for pooled estimates.</p><p><strong>Evidence synthesis: </strong>Fifteen studies (N.=1, 593 patients) were included. Membranectomy reduced recurrence by 54.2% (pooled OR: 0.45, 95% CI: 0.33-0.62, P<0.001), with moderate heterogeneity (I²=38%). Functional outcomes improved (GOS 4-5: OR 1.42; 1.18-1.71), but seizure risk increased (OR=1.89; 1.32-2.71). Craniotomy with complete membranectomy was most effective for organized hematomas. While subdural drains were most beneficial for partial membranectomy in reducing hematoma recurrence, it demonstrated no benefit with complete membranectomy.</p><p><strong>Conclusions: </strong>Membranectomy significantly reduces recurrence but increases seizure risk. Burr-hole drainage remains first-line for uncomplicated CSDH, while craniotomy with membranectomy may benefit organized/recurrent cases.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 1","pages":"75-85"},"PeriodicalIF":1.2,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146180627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}