Journal of neurosurgery最新文献

{"title":"The impact of perilesional heatsink structures on ablation volumes and symmetry in laser interstitial thermal therapy for the treatment of primary central nervous system tumors.","authors":"Chandler N Berke, Cameron A Rivera, Shovan Bhatia, David Levi, Adham M Khalafallah, Victor M Lu, Kate Stillman, Chase DeLong, Eric Singh, Adam Levy, Ashish H Shah, Ricardo J Komotar, Michael E Ivan","doi":"10.3171/2025.1.JNS241377","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241377","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment for primary CNS tumors. While LITT offers advantages over traditional approaches, perilesional intracranial heatsinks can lead to asymmetrical ablation, impacting patient outcomes. Understanding heatsink effects is crucial for optimizing LITT efficacy.</p><p><strong>Methods: </strong>The authors retrospectively analyzed primary CNS tumors treated with LITT at a single tertiary care center. Ablation outcomes were quantified using the Heatsink Effect Index (HEI), measured on a scale of 0-1 (0 = total symmetry, 1 = complete asymmetry), and extent of ablation (EOA). The heatsink types evaluated were sulci, meninges, vasculature, and CSF spaces, inclusive of ventricles, resection cavities, and CSF cisterns. Statistical analyses were performed to assess the relationship between heatsink proximity and type and ablation outcomes.</p><p><strong>Results: </strong>A total of 99 patients satisfied all selection criteria. The cohort was 53% female, with a mean age of 61 years. Glioblastoma was the most predominant tumor type (78%), followed by low-grade glioma (15%) and meningioma (4%). Heatsink proximity significantly correlated with ablation asymmetry (HEI) (p < 0.001), particularly at the midpoint of the catheter trajectory. The correlation between closest heatsink distance and HEI varied across the different heatsink types, with distance to vasculature and CSF spaces correlating the strongest with ablation asymmetry. When assessing the relationship between EOA and medial HEI during suboptimal ablations (EOA < 100%), a negative correlation was demonstrated, showing improved EOA as HEI was reduced. Optimal cutoff catheter-heatsink distances for predicting ablation asymmetry ranged from 6.6 to 13.0 mm, emphasizing the impact of heatsink proximity on LITT efficacy.</p><p><strong>Conclusions: </strong>This study shows that proximity to heatsinks, especially within a threshold distance of 13.0 mm from the laser catheter, significantly predicts ablation asymmetry and volume in the setting of primary CNS tumors. Vasculature and CSF spaces demonstrate the strongest heatsink effects. Neurosurgeons should consider heatsink effects in pre- and intraoperative planning to optimize LITT outcomes and preserve normal brain tissue.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microsurgical management of 883 previously coiled intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of its effectiveness and safety.","authors":"Keng Siang Lee, Oliver Wroe-Wright, John J Y Zhang, Ahilan Kailaya-Vasan, Ramez Kirollos, Julian Han, Pascal Jabbour, Michael T Lawton","doi":"10.3171/2025.2.JNS242565","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242565","url":null,"abstract":"<p><strong>Objective: </strong>With the increasing number of intracranial aneurysms (IAs) treated by endovascular coiling, more residual and recurrent IAs are being encountered. This study aimed to evaluate the effectiveness and safety of the microsurgical management of these previously coiled IAs.</p><p><strong>Methods: </strong>Systematic searches of the Medline, Embase, and Cochrane Central databases were performed. The primary outcome was good functional outcome (modified Rankin Scale score 0-2 or Glasgow Outcome Scale score 4-5) and unchanged/improved functional outcomes at the last follow-up. Secondary outcomes included intraoperative rupture, complete occlusion confirmed on imaging, and perioperative complications and death within 30 days.</p><p><strong>Results: </strong>Thirty-nine studies reporting on 874 patients with 883 previously coiled IAs managed by microsurgery were included in the meta-analysis. Of the 883 IAs, 656 (74.3%), 167 (18.9%), 44 (5.0%), and 16 (1.8%) underwent direct clipping, clipping with coil removal, bypass, and trapping, respectively. Forty-five (5.1%), 806 (91.3%), and 32 (3.6%) IAs were classified as Gurian group A, B, and C. IAs were located anteriorly in 88.2% and posteriorly in 11.8%; 45.3% were < 7 mm, 31.3% were 7-12 mm, 14.6% were 13-24 mm, and 8.8% were > 25 mm. The overall mean clinical follow-up duration was 33.7 months. Overall proportions of intraoperative rupture, perioperative stroke, and death were 0.1% (95% CI 0.0%-1.1%, I2 = 25.2%), 8.2% (95% CI 5.85%-11.34%, I2 = 52.8%), and 3.7% (95% CI 2.63%-5.24%, I2 = 0.0%), respectively. The proportions of complete occlusion, good, and improved/unchanged functional outcomes were 97.2% (95% CI 95.82%-98.13%, I2 = 0.0%), 82.9% (95% CI 79.67%-85.69%, I2 = 5.1%), and 92.3% (95% CI 89.27%-94.54%, I2 = 0.0%), respectively. Direct clipping of unruptured anterior circulation IAs was associated with the lowest proportion of intraoperative rupture, perioperative stroke, and death. Direct clipping was also associated with the greatest proportion of complete occlusion, good functional outcome, and improved/unchanged neurological outcome. Microsurgery within 1 month of endovascular coiling and management of Gurian group C IAs were associated with greater proportions of perioperative death.</p><p><strong>Conclusions: </strong>Microsurgical management of previously coiled IAs is an effective and safe strategy in well-selected patients. Important factors to consider in the management of these IAs include the size and location of the IA, rupture status at initial presentation, indication for microsurgery, and type and timing of microsurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting patients with poor functional outcome after spontaneous aneurysmal subarachnoid hemorrhage: the predicting subarachnoid hemorrhage long-term outcome score.","authors":"Marie Renaudier, Vincent Degos, Gianluca Pisanu, Benjamin Granger, Lamine Abdennour, Caroline Tabillon, Dany Hijazi, Anne-Laure Boch, Bertrand Mathon, Frédéric Clarençon, Eimad Shotar, Louis Puybasset, Rémy Bernard, Alice Jacquens","doi":"10.3171/2025.2.JNS242210","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242210","url":null,"abstract":"<p><strong>Objective: </strong>Subarachnoid hemorrhage (SAH) is a critical condition with high morbidity and mortality. Despite medical advances, predicting functional outcomes 1 year after the hemorrhage remains challenging. The aim of this study was to develop, compare, and validate a predictive score for 1-year functional outcomes after SAH.</p><p><strong>Methods: </strong>This monocentric, retrospective observational study included all adults admitted to a neurosurgical ICU for aneurysmal SAH from 2002 to 2020, excluding moribund patients. The primary endpoint was a poor 1-year functional outcome, defined as a modified Rankin Scale score of 4 to 6. Independent risk factors for poor outcomes were identified using multivariate logistic regression in a derivation cohort. The predicting SAH long-term outcome (PSL) score was compared with the World Federation of Neurosurgical Societies (WFNS), Fisher, and admission bioclinical scores and validated in an independent cohort.</p><p><strong>Results: </strong>In the overall population (n = 1564), 21% experienced poor functional outcomes at 1 year. In the derivation cohort (n = 1095), independent predictors of poor outcomes included age (p < 0.001), WFNS score (p < 0.001), troponin level (p = 0.007), S100β level (p = 0.01), surgical or coiling complications (p < 0.001), incomplete aneurysm exclusion (p = 0.03), and hydrocephalus requiring CSF drainage (p = 0.002). The PSL score achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.85 (95% CI 0.82-0.88), outperforming other scores. These findings were consistent across various subgroups. In the validation cohort (n = 469), the PSL score achieved an ROC-AUC of 0.80 (95% CI 0.74-0.85), surpassing the WFNS and Fisher scores, with a negative predictive value of 95% (95% CI 94%-97%).</p><p><strong>Conclusions: </strong>The authors developed a simple and effective score to identify predictors of poor 1-year functional outcomes at admission and early after aneurysmal SAH in a large cohort.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shedding light on tiny intracranial aneurysms: a retrospective risk assessment.","authors":"Jennifer Sauvigny, Safouh Muzaiek, Patrick Czorlich, Franz L Ricklefs, Maxim Bester, Thomas Sauvigny, Lasse Dührsen","doi":"10.3171/2025.2.JNS242537","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242537","url":null,"abstract":"<p><strong>Objective: </strong>Tiny intracranial aneurysms (tiAs) pose challenges in detection and management. Recent advances in neuroimaging have improved the detection rates of these diminutive lesions, yet the decision-making process regarding their treatment remains controversial. While larger aneurysm size is a relevant risk factor for a possible rupture in common risk scores, the rupture of tiAs leading to subarachnoid hemorrhage (SAH) is also reported frequently. However, a heterogeneity in practice exists, and clear guidelines for the treatment of incidental tiAs are lacking. The aim of this study was to investigate clinical decision-making for aneurysm repair by investigating the risk factors for rupture in tiny aneurysms.</p><p><strong>Methods: </strong>This retrospective analysis utilized data from patients admitted to the University Medical Center Hamburg-Eppendorf for aneurysmal SAH (n = 427) between 2010 and 2020 and patients with unruptured intracranial aneurysm (UIAs) discussed by the medical center's aneurysm board (n = 743) between 2012 and 2022. Patients with single tiAs, defined as a maximum diameter of 3 mm, were selected for further analysis. Patient demographics, aneurysm characteristics, and risk factors were compared between the SAH and UIA groups. A modified UIA treatment score (UIATS*) and the PHASES (population, hypertension, age, size of aneurysm, earlier SAH from another aneurysm, site of aneurysm) score were collected in UIA patients and applied retrospectively in SAH patients for the time of admission.</p><p><strong>Results: </strong>The authors identified 79 tiAs in the SAH cohort and 109 tiAs in the UIA cohort. Irregular morphology (OR 4.53, 95% CI 1.84-11.16; p < 0.001) and a high size ratio/aspect ratio (> 3/1.6; OR 14.73, 95% CI 3.55-61.17; p < 0.001) were significantly associated with rupture when comparing tiAs of the SAH and UIA groups. When applying the UIATS* to tiny aneurysms retrospectively, intervention would have been recommended in 20.3% of SAH cases compared with 0.9% of UIA cases (p < 0.001). Comparatively, for nontiny aneurysms, intervention would have been recommended in 33.9% of SAH cases compared with 15.6% of UIA cases (p < 0.001).</p><p><strong>Conclusions: </strong>In the present collective, several ruptured tiAs could be identified. Nevertheless, only a few would have been recommended for treatment. Especially tiAs with irregular morphology and abnormal configurations should be critically evaluated for rupture risk. Current scoring systems provide valuable guidance but should be used in conjunction with individualized, multidisciplinary treatment approaches.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The origins of neurosurgery at the University of South Florida in Tampa Bay.","authors":"Keaton Piper, Jay I Kumar, Donald Smith, Thomas Freeman, Fernando L Vale, Mark Greenberg, Gene Balis, Harry van Loveren","doi":"10.3171/2025.1.JNS242646","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242646","url":null,"abstract":"<p><p>Academic neurosurgery in Tampa, Florida, had a recent expeditious beginning, ultimately leading to the foundation of the University of South Florida (USF) neurosurgery residency under the tutelage of Dr. David W. Cahill in 1987. In this paper, the authors summarize the important events and people who have made USF neurosurgery possible. Through faculty interviews and literature review, a summary of the history of USF neurosurgery was developed and confirmed by multiple sources. While the USF neurosurgery program is still young, it has made significant regional and national contributions to the field during the couple decades under the guidance of Dr. David Cahill and then Dr. Harry van Loveren. Presented is an account of the faculty, sites, trainees, and important events spanning the history of USF neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative neural firing correlates with motor and cognitive features in Parkinson's disease.","authors":"Natasha C Hughes, Danika L Paulo, Michael Zargari, Derek J Doss, Saramati Narasimhan, Robert Shults, Rui Li, Benoit M Dawant, Kaltra Dhima, Hakmook Kang, Travis J Hassell, Tyler J Ball, Dario J Englot, Sarah K Bick","doi":"10.3171/2025.1.JNS241414","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241414","url":null,"abstract":"<p><strong>Objective: </strong>During deep brain stimulation (DBS) surgery for Parkinson's disease (PD), intraoperative microelectrode recordings (MERs) are frequently used to determine electrode positioning within the subthalamic nucleus (STN) and globus pallidus internus (GPi). Various patient characteristics might be associated with abnormal STN and GPi firing activity and thus influence electrode placement. In this study, the authors aimed to elucidate the relationship between preoperative dopamine responsiveness or changes in cognitive status and STN or GPi multiunit activity.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with PD undergoing awake STN (n = 74) or GPi (n = 63) DBS surgery with intraoperative MER at a single institution from 2013 to 2021. To control for the lead position, contralateral motor outcomes of each lead were graded using 1-year neurological follow-up notes. Multiunit neural firing activity for each lead was recorded from MER at the location corresponding to lead active contact at the 1-year follow-up assessment. Linear regression models, controlling for disease duration and age, were used to identify associations between multiunit neural firing rates and preoperative dopamine responsiveness, determined by the difference between preoperative motor scores when on medication minus preoperative motor scores when off medication, and between multiunit activity and the pre- to postoperative change in Mini-Mental State Examination scores.</p><p><strong>Results: </strong>Seventy-four patients with 130 STN leads (mean age 61.2 ± 10.4 years) and 63 patients with 110 GPi leads (mean age 62.8 ± 8.6 years) were included. In STN leads with maximum contralateral motor improvement, increased dopamine responsiveness was associated with both the intraoperative firing rate (p = 0.01) and disease duration (p = 0.01). These relationships were not significant in the GPi leads or when looking at leads for which patients experienced suboptimal motor improvement (p > 0.05). In the GPi leads, an increased intraoperative firing rate in electrodes with maximum symptom improvement was associated with declining cognitive status (p = 0.045).</p><p><strong>Conclusions: </strong>These findings suggest patient characteristics that correlate with neural firing rates and influence intraoperative MER, final electrode placement, and patient outcomes, while improving understanding of STN and GPi pathophysiologic mechanisms in PD. Future investigations into other characteristics that might affect STN and GPi intraoperative neurophysiology are warranted.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex disparity in patients with Parkinson's disease treated using deep brain stimulation.","authors":"Muhammad Faran, Danielle A Pietramala, Franziska A Schmidt, Nancy E Polyhronopoulos, Mandeep K Sandhu, Jessica Dong, Natasha Sarai, Christopher R Honey, Stefan Lang","doi":"10.3171/2025.1.JNS241670","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241670","url":null,"abstract":"<p><strong>Objective: </strong>Studies have suggested that there may be sex differences in the preoperative characteristics and postoperative outcomes of patients with Parkinson's disease (PD) treated with subthalamic nucleus (STN) deep brain stimulation (DBS). Authors of this study aimed to reveal differences in preoperative and 1-year postoperative motor symptoms, dopaminergic medication use, and quality of life (QOL) domains between men and women who had undergone STN DBS.</p><p><strong>Methods: </strong>In this retrospective cohort study, the authors evaluated patients who underwent bilateral STN DBS at a single center from 2008 to 2023. Motor symptoms were measured using the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III), levodopa equivalent daily dose (LEDD) was used to measure the dosage of dopaminergic medications, and the 39-Item Parkinson's Disease Questionnaire (PDQ-39) was used to determine QOL outcomes. Exploratory linear mixed-effect models were used to investigate sex and time interactions for the UPDRS-III, LEDD, and PDQ-39 scores.</p><p><strong>Results: </strong>Ninety-four patients, 26 females and 68 males, were included in the study. Preoperatively, women presented with a significantly longer disease duration (p = 0.014), greater UPDRS-III off-medication scores (p < 0.001), lower LEDDs (p = 0.001), and worse PDQ-39 mean total score (p < 0.001). One year postoperatively, after adjusting for disease duration, age, UPDRS-III off scores, and LEDD, there was a significant sex and time interaction for the cognition domain of the PDQ-39, which showed worsening over time in women (p = 0.009). There was no significant sex and time interaction in the UPDRS-III off-medication/on-stimulation scores.</p><p><strong>Conclusions: </strong>Although STN DBS is equally clinically efficacious for both sexes, women are treated later in the disease course. Preoperatively, women present during more advanced stages of PD with worse motor symptoms and a lower QOL. Postoperatively, women score worse on the cognition index, a proxy for mood rather than cognition.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for mesial temporal pathology: a 26-year experience.","authors":"Tucker A Oliver, Matthew L Lee, Keaton F Piper, M Salman Ali, Fernando L Vale","doi":"10.3171/2025.1.JNS242375","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242375","url":null,"abstract":"<p><strong>Objective: </strong>Mesial temporal lobe (MTL) surgery continues to be challenging to the novice surgeon. The aim of this study was to understand the nuances of MTL surgery using a keyhole craniotomy via an inferior temporal gyrus (ITG) access corridor. In addition, the authors reviewed associated complications and considered strategies for prevention.</p><p><strong>Methods: </strong>A single-surgeon IRB-approved database for epilepsy surgery was established in 1998, and cases from 1998 to 2022 were reviewed. After patients with high-grade gliomas with extensive temporal extension were excluded due to their extensive comorbidities and need for specialized postoperative care, 717 patients were included and operative complications were documented. Resection of the mesial structures was the primary goal of the surgical interventions. Complications were grouped as nonneurological (infection, CSF leakage, cosmetic defect [e.g., temporalis muscle atrophy], and extraaxial hemorrhage) and neurological (postoperative seizure, visual field deficit [VFD], cerebrovascular accident, cranial nerve deficit, and speech difficulty).</p><p><strong>Results: </strong>Among the 717 patients (mean age 37 years), 38 patients had complications, with an overall complication rate of 5.3%. Complications included transient word-finding difficulty (n = 1), lacunar stroke (n = 1), VFD (n = 1), transient cranial nerve deficit (n = 2), cosmetic defect (n = 4), CSF leakage/pseudomeningoceles (n = 4), infection (n = 5), postoperative seizure (n = 9), and hemorrhage (n = 11). Of those complications, lacunar stroke and VFD in 2 patients (0.3%) were associated with permanent neurological deficits. No deaths were reported in the perioperative period. No major medical complications occurred, such as deep vein thrombosis or myocardial infarction.</p><p><strong>Conclusions: </strong>Keyhole craniotomy with the ITG approach to MTL resection was a safe and effective method for treating temporal lobe pathology. Careful examination of the complications associated with this procedure demonstrated healthy maturation of the technique, evolution of strategies to effectively educate young surgeons, and systematic implementation of appropriate perioperative management to minimize complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RECOVER study: a multicenter retrospective cohort study and comparison of the efficacy and safety of clazosentan and fasudil in patients with aneurysmal subarachnoid hemorrhage.","authors":"Shinsuke Muraoka, Takashi Izumi, Kazuki Nishida, Basile Chrétien, Kazuki Ishii, Issei Takeuchi, Masahiro Nishihori, Shunsaku Goto, Satoshi Maesawa, Shinji Shimato, Takeshi Kinkori, Takumi Asai, Osamu Suzuki, Ryuta Saito","doi":"10.3171/2025.1.JNS242509","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242509","url":null,"abstract":"<p><strong>Objective: </strong>Delayed cerebral ischemia (DCI) is a crucial determinant of the prognosis of patients with aneurysmal subarachnoid hemorrhage (aSAH). In Japan, fasudil has traditionally been used to prevent cerebral vasospasm after aSAH. The effectiveness of clazosentan, a selective endothelin receptor A antagonist, in preventing cerebral vasospasm, a significant contributor to DCI, was recently demonstrated. This study aimed to compare the efficacy and safety of perioperative management using clazosentan- and fasudil-based therapies.</p><p><strong>Methods: </strong>This multicenter, retrospective observational cohort study included 466 patients with aSAH. Patients were categorized into two groups based on the perioperative management administered: clazosentan or fasudil. Data on patient characteristics, treatment outcomes (assessed using the modified Rankin Scale [mRS] at discharge), and complications (including angiographic cerebral vasospasm, vasospasm-related DCI, pulmonary complications, hypotension, brain edema, and de novo intracerebral hemorrhage) were collected. Statistical analyses were conducted using inverse probability of treatment weighting to adjust for selection bias.</p><p><strong>Results: </strong>Clazosentan was significantly more effective than fasudil in preventing angiographic cerebral vasospasm (33.7% of fasudil-treated patients had vasospasm vs 15.4% of clazosentan-treated patients, p < 0.001) and vasospasm-related DCI (10.2% fasudil vs 4.4% clazosentan, p = 0.007). This improved effectiveness resulted in significantly better outcomes at discharge (50.5% of fasudil-treated patients had an mRS score of 0-2 vs 62.2% of clazosentan-treated patients, p = 0.005). Although clazosentan has been reportedly associated with fluid retention complications, no significant differences in the incidence rates of pulmonary complications or brain edema were found between the groups in this study, likely because of improved fluid management protocols. Clazosentan may also be effective in severe cases or for use in elderly patients aged ≥ 75 years.</p><p><strong>Conclusions: </strong>Clazosentan outperformed fasudil in preventing cerebral vasospasm and improving overall outcomes in patients with aSAH. Despite initial concerns regarding fluid retention, appropriate perioperative management mitigated these risks, making clazosentan a superior treatment option across different patient groups.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in glioblastoma treatment, survival, and disparities in access to care in the United States from 2004 to 2019: a National Cancer Database analysis.","authors":"John Pham, Jonathan Sisti, David J Cote, Keiko Kang, Robert G Briggs, David Gomez, Ishan Shah, Sean E Lawler, Clark C Chen, Frank Attenello, Gabriel Zada","doi":"10.3171/2025.1.JNS242671","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242671","url":null,"abstract":"<p><strong>Objective: </strong>Population-based studies of histologically confirmed glioblastoma without molecular classification have demonstrated the doubling of 3-year overall survival (OS) since 2005 despite minimal additions to the treatment armamentarium. The authors aimed to evaluate whether changes in tumor characteristics and treatment patterns were associated with survival outcomes. Additionally, the authors sought to elucidate disparities in access to established and novel therapeutic modalities for patients with glioblastoma.</p><p><strong>Methods: </strong>The authors queried all patients diagnosed with glioblastoma by histology irrespective of biomarkers from the National Cancer Database and divided patients into 4 equal periods: 2004-2007, 2008-2011, 2012-2015, and 2016-2019. The chi-square test and independent t-test/ANOVA were used to assess associations between categorical and continuous variables, respectively. Differences in OS were tested using the Kaplan-Meier log-rank test. Logistic regression models were constructed to identify predictors of receiving trimodal therapy (surgery, radiation, and chemotherapy) and immunotherapy.</p><p><strong>Results: </strong>A total of 127,737 patients with glioblastoma were included, of whom 74,387 (58.2%) were males. The proportion of patients receiving trimodal therapy (48.7% vs 60.0%) significantly increased from period 1 to period 4 (p < 0.001). There were higher rates of gross-total resection (28.6% [period 3] vs 33.8% [period 4]), greater total radiation doses of 60 Gy delivered (39.4% [period 1] vs 60.0% [period 4]), increased use of intensity-modulated radiotherapy (16.3% [period 1] vs 62.0% [period 4]), and decreased use of stereotactic radiosurgery (1.5% [period 1] vs 0.8% [period 4]) across the study period (all p < 0.001). Lower total radiotherapy doses (≤ 40.05 Gy) were more commonly administered to elderly patients (≥ 70 years) over time, increasing from 23.4% in period 1 to 42.5% in period 4 (p < 0.001). The use of immunotherapy increased 15-fold (0.4% in period 1 vs 6.2% in period 4, p < 0.001). Comparatively, 2-year OS (17.6% vs 24.6%) and 3-year OS (10.0% vs 15.5%) both increased from period 1 to period 4 (p < 0.001). Patient age, race/ethnicity, education level, insurance status, and treatment facility location/type were independent predictors of receiving trimodal therapy and immunotherapy.</p><p><strong>Conclusions: </strong>Improvements observed in OS for glioblastoma over the past 2 decades were associated with an increased use of trimodal therapy in accordance with clinical guidelines. Addressing ongoing disparities in the access to established and novel therapeutic modalities for glioblastoma is necessary to optimize outcomes and enhance research discoveries.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}