Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Methodological concerns regarding a TriNetX-based analysis of GLP-1-RA use following IIH.","authors":"Kuo-Feng Huang, Kuo-Cheng Lu, Kuo-Wang Tsai, Joshua Wang","doi":"10.3171/2025.6.JNS251620","DOIUrl":"https://doi.org/10.3171/2025.6.JNS251620","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313091","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":"Pneumocephalus after posterior fossa surgery in the lounging position: risk analysis of intracranial air collections and clinical outcome by voxel-based volumetry.","authors":"Helene Hurth, Florian H Ebner, Kathrin Machetanz, Berthold Drexler, Marcos Tatagiba, Georgios Naros","doi":"10.3171/2025.6.JNS25715","DOIUrl":"https://doi.org/10.3171/2025.6.JNS25715","url":null,"abstract":"<p><strong>Objective: </strong>Semisitting or lounging patient positions offer several advantages in neurosurgical procedures, particularly for the resection of large and highly vascularized posterior fossa lesions. However, concerns persist regarding potentially severe complications such as tension pneumocephalus (TP) and venous air embolisms. The aim of this study was to assess the extent and distribution of postoperative pneumocephalus and to identify risk factors of TP.</p><p><strong>Methods: </strong>This retrospective analysis included consecutive patients who underwent posterior fossa surgery in the lounging position from January 2010 to November 2020 at a single center. Postoperative cranial CT scans acquired within 24 hours after surgery were registered and normalized to the common Montreal Neurological Institute space to measure intraventricular, subdural, and total intracranial air using voxel-based volumetry. TP was defined as intracranial air associated with reduced consciousness, and its treatment was typically performed via external ventricular drain (EVD) placement or subdural air exchange through mini burr hole trepanation. Patient characteristics, surgical details, and clinical outcome were evaluated.</p><p><strong>Results: </strong>Overall, 836 patients (462 female, mean age 48.7 years) were included. The indication for surgery was resection of a posterior fossa tumor (96.1%, n = 803), vascular pathology (2.6%, n = 22), malformation (1.1%, n = 9), or other pathology (0.2%, n = 2). Lateral suboccipital and midline suboccipital approaches were performed in 93.8% (n = 784) and 6.2% (n = 52) of patients, respectively. Intracranial air was detected in all patients, with a mean volume of 74 ± 59 mL. The volumetric analysis revealed significantly higher mean volumes of intracranial air (midline: 94 ± 72 mL, lateral: 73 ± 58 mL) [t(828) = 2.44, p = 0.008 (95% CI 4-38)] and intraventricular air (midline: 29 ± 32 mL, lateral: 3 ± 14 mL) [t(828) = 11.36, p < 0.001 (95% 21-30)] in midline approaches compared with lateral approaches. TP occurred in 3.0% of patients, with higher rates (15.4%) in those who underwent midline craniotomies compared with lateral approaches (2.0%) [χ2(1) = 31.14, p < 0.001]. Patients with TP required longer ventilation, intensive care unit stays, and hospitalizations, although Karnofsky Performance Status scores did not differ significantly at follow-up. The logistic regression analysis identified surgical approach, age, duration of surgery, and sex as independent predictors of TP [χ2(4) = 41.34, p < 0.001]. The area under the curve (AUC) analysis indicated that intraventricular air volumes ≥ 27.6 mL were associated with EVD placement (AUC = 0.92, sensitivity = 0.90, specificity = 0.95). TP was managed effectively in all cases, with no long-term sequelae.</p><p><strong>Conclusions: </strong>These findings suggest that the lounging position can be performed safely with careful monitoring for TP, particularly in old","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313092","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":"Letter to the Editor. Advanced MRI in TN diagnosis and treatment.","authors":"Luigi Albano, Silvia Basaia, Lina Raffaella Barzaghi, Edoardo Pompeo, Filippo Valtorta, Antonella Castellano, Andrea Falini, Federica Agosta, Pietro Mortini, Massimo Filippi","doi":"10.3171/2025.6.JNS251467","DOIUrl":"https://doi.org/10.3171/2025.6.JNS251467","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313090","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":"Near-total resection in sporadic vestibular schwannoma: is there a volumetric threshold for a win-win scenario?","authors":"Daniela Stastna, Robert Macfarlane, Richard Mannion, Patrick Axon, Manohar Bance, Neil Donnelly, James R Tysome, Mathew R Guilfoyle, Daniele Borsetto, Simon Duke, Sarah Jefferies, Indu Lawes, Juliette Buttimore, Ari Ercole, Jonathan P Coles","doi":"10.3171/2025.6.JNS242466","DOIUrl":"https://doi.org/10.3171/2025.6.JNS242466","url":null,"abstract":"<p><strong>Objective: </strong>Surgical management of large vestibular schwannoma (VS; Koos grades III and IV) requires a balance between the maximum extent of resection and the best functional preservation. The primary objective of this study was to determine the volumetric threshold of the VS residual tumor at risk of progression after incomplete resection. The secondary objective was to identify other risk factors of regrowth after incomplete resection.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent incomplete resection of sporadic VS at a single center from January 2008 to December 2018. The inclusion criteria were: adult age, large single sporadic VS, incomplete resection, and follow-up of > 5 years. Quantitative 3D volumetry was assessed on pre- and postoperative contrast-enhanced T1-weighted MRI using semiautomated segmentation. The volumetric criteria for residual tumor were < 250 mm3 for near-total resection (NTR) and < 2 cm3 for subtotal resection (STR). Univariate and multivariate logistic regression analyses were performed to assess predictors of regrowth after incomplete resection. A residual volume cutoff for risk of regrowth was determined using the Youden index via area under the curve analysis.</p><p><strong>Results: </strong>The cohort included 119 patients (60 female, median age 58 years) who were categorized into 3 subgroups based on the residual VS according to 3D volumetry: NTR, STR, and partial resection (PR). NTR achieved the best long-term tumor control. Kaplan-Meier progression-free survival rates at 2, 5, and 10 years were 98%, 97%, and 95% for the NTR group; 69%, 56%, and 56% for the STR group; and 20%, 0%, and 0% for the PR group, respectively (p < 0.0001). The cutoff residual volume at risk of growth was 200 mm3, with sensitivity of 95% (95% CI 74%-99%) and specificity of 77% (95% CI 68%-85%, p < 0.001). Moreover, good facial nerve outcomes (House-Brackmann grades I and II) were best achieved with PR (100%), followed by STR (96%) and NTR (90%). In the univariate analysis, the risk factors for regrowth of residual tumor were cystic morphology, residual volume, and residual location (internal auditory canal, cisternal segment, and brainstem combined). The multivariate model identified the volume and location of residual as risk factors (p < 0.0001).</p><p><strong>Conclusions: </strong>These findings suggest that limited NTR (< 250 mm3) offered an excellent compromise, with long-term tumor control comparable to that of radical resection while preserving superior functional preservation. The authors hope to stimulate discussion toward a unified volumetrically established classification of incomplete resections, allowing for cooperation in future multicenter studies.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274875","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":"Multiple arachnoid membrane opening to promote angiogenesis in adult patients with moyamoya disease after combined bypass surgery: a multicenter randomized controlled clinical trial.","authors":"Songtao Qi, Tinghan Long, Liming Zhao, Erming Zeng, Chengliang Mao, Cong Ling, Jianjian Zhang, Zhenyu Zhang, Guozhong Zhang, Mingzhou Li, Shichao Zhang, Yunyu Wen, Huibin Kang, Peng Li, Hui Wang, Yabo Huang, Wenfeng Feng, Gang Wang","doi":"10.3171/2025.5.JNS25385","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25385","url":null,"abstract":"<p><strong>Objective: </strong>In adult patients with moyamoya disease (MMD), insufficient postoperative collateral formation is usually seen after combined bypass surgery. The arachnoid membrane, a critical anatomical barrier between extracranial and intracranial vascular systems, has an unclear role in postoperative angiogenesis. The aim of this study was to investigate whether intraoperative arachnoid membrane opening enhances angiogenesis in adult patients undergoing combined bypass surgery for MMD.</p><p><strong>Methods: </strong>This multicenter, prospective, randomized controlled trial (Membrane Opening to Promote Angiogenesis in Adult MMD [MOPOAM]) was conducted across 8 institutions in China. Between June 2022 and August 2023, 104 patients diagnosed with MMD through digital subtraction angiography were randomly assigned to two groups: one group underwent arachnoid opening (n = 51), while the other group had arachnoid preservation (n = 53). The primary endpoint was the rate of good angiogenesis (Matsushima grade A and B) assessed 6-12 months postoperatively, and the secondary endpoint was the incidence of surgical complications within 1 month postsurgery.</p><p><strong>Results: </strong>All 104 patients completed the study. The rate of good angiogenesis was 54.9% in the arachnoid opening group and 64.2% in the arachnoid preservation group, with no significant difference between groups (OR 1.470, 95% CI 0.669-3.229; p = 0.337). Postoperative complications were observed in 2 patients (3.9%) in the arachnoid opening group and in 5 patients (9.4%) in the arachnoid preservation group, showing no significant difference (OR 2.552, 95% CI, 0.472-13.796; p = 0.276). No significant association between arachnoid opening procedures and functional recovery (assessed by modified Rankin Scale scores) was found during the 6- to 12-month follow-up period (p = 0.831).</p><p><strong>Conclusions: </strong>In adults with MMD, arachnoid membrane opening during combined bypass surgery did not significantly improve postoperative angiogenesis rates or increase perioperative complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274836","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":"Focused ultrasound capsulotomy: predicting the probability of successful lesioning based on skull morphology.","authors":"Emmanuel De Schlichting, Yuexi Huang, Ryan M Jones, Ying Meng, Xingshan Cao, Anusha Baskaran, Kullervo Hynynen, Clement Hamani, Nir Lipsman, Maged Goubran, Benjamin Davidson","doi":"10.3171/2025.6.JNS2588","DOIUrl":"https://doi.org/10.3171/2025.6.JNS2588","url":null,"abstract":"<p><strong>Objective: </strong>MR-guided focused ultrasound anterior capsulotomy (MRgFUS-AC) is an incisionless ablative procedure, which has shown reassuring safety and compelling efficacy in the treatment of refractory obsessive-compulsive disorder and major depressive disorder. However, in some patients lesions cannot be reliably generated due to patient-specific skull morphologies and properties. Despite screening patients for MRgFUS-AC using skull density ratio (SDR), up to 25% of cases experience treatment failure. This variability in technical success limits the real-world applicability of an otherwise highly impactful treatment, and a better predictor of success is needed.</p><p><strong>Methods: </strong>This study analyzed data from 60 attempted MRgFUS-AC treatments in 57 patients between 2017 and 2024. Treatments were categorized as success or failure based on lesion volume. Preoperative parameters, including SDR, skull thickness, angle of incidence, CSF volume, brain and head volumes, and lesion side, were recorded. Logistic and machine learning models were evaluated to construct a preoperative model to predict the probability of technical success.</p><p><strong>Results: </strong>A total of 157 lesions were treated, of which 31 experienced treatment failure. Higher SDR, thinner skulls, and lower incident angles were significantly associated with successful outcomes (all p < 0.05). The logistic regression model performed the best among the models tested, with an accuracy of 0.81 ± 0.07 and an F1 score of 0.89 ± 0.04. The model was incorporated into a predictive tool to aid in identifying candidates for MRgFUS-AC.</p><p><strong>Conclusions: </strong>SDR, skull thickness, and angle of incidence significantly influenced the likelihood of successful MRgFUS-AC lesioning. Incorporating these three parameters into a predictive tool can dramatically reduce technical failure rates and may be especially informative in patients with an SDR between 0.35 and 0.55.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274815","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":"Letter to the Editor. Immunogenic amplification of focused ultrasound therapy.","authors":"Matteo Palermo, Carmelo Lucio Sturiale","doi":"10.3171/2025.6.JNS251613","DOIUrl":"https://doi.org/10.3171/2025.6.JNS251613","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274850","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":"Common peroneal nerve schwannomas around the knee: a surgical case series of 44 patients and systematic review of the literature.","authors":"Godard C W de Ruiter, Kirsten M Hayford, Thomas F H Vissers, Robert J Spinner","doi":"10.3171/2025.5.JNS25705","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25705","url":null,"abstract":"<p><strong>Objective: </strong>Resection of common peroneal nerve (CPN) schwannomas is generally believed to be associated with a high risk of postoperative deficit, especially the chance for development of a foot drop. The goal of this study was to investigate the surgical results for resection of schwannomas from the CPN around the knee and specifically the chance of developing a postoperative motor deficit.</p><p><strong>Methods: </strong>Data from 36 patients with sporadic schwannomas and 8 patients with schwannomatosis (12 schwannomas total) treated at two centers were retrospectively analyzed. For sporadic cases, different locations around the knee were compared (i.e., proximal to the fibular head [FH], at the FH, and distal to the FH), taking into account the preoperative duration of symptoms, size at presentation, and surgical results of resection. The literature was systematically reviewed for reported cases by searching the PubMed and Embase databases.</p><p><strong>Results: </strong>A total of 24 schwannomas proximal to the FH were surgically treated: 11 at the FH, and 13 distal to the FH. For the entire cohort, the mean size of CPN schwannomas distal to the FH at presentation was smaller (1.4 × 1.8 cm) compared with those proximal to (2.0 × 2.2 cm) and at (2.2 × 2.3 cm) the FH, although these differences were not statistically significant. The mean preoperative duration of symptoms was slightly longer for schwannomas distal to the FH (35 months) than for those proximal to the FH (21 months) and at the FH (27 months); however, this difference was not significant. Postoperative deficits occurred in 3 sporadic cases: 2 patients with temporary weakness (Medical Research Council grade 4) that completely resolved within several months and 1 patient who had previously undergone surgery elsewhere and presented with deficits and in whom weakness increased after resection. Improvement in preoperative deficits was observed in 1 patient with extensor hallucis longus muscle paralysis that completely recovered. One patient with schwannomatosis developed muscle weakness after resection of a plexiform schwannoma. A systematic review of 21 previously reported cases in the literature showed that larger CPN schwannomas (> 5 cm) were more likely to result in permanent motor deficits.</p><p><strong>Conclusions: </strong>This retrospective study of 44 patients shows that peroneal nerve schwannomas around the knee can be safely removed with a low risk of deficits. The systematic review of the literature suggests that larger schwannomas are more likely to result in permanent deficit. In the authors' opinion, CPN schwannomas can best be resected, preferably when the lesion is relatively small.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225501","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":"Impact of GLP-1 receptor agonists on stroke, subarachnoid hemorrhage, and intracerebral hemorrhage: a propensity-matched multi-institutional cohort study.","authors":"Matias Costa, Sean O'Leary, Anthony M Price, Christopher C Young, Visish M Srinivasan, Peter Kan","doi":"10.3171/2025.5.JNS25786","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25786","url":null,"abstract":"<p><strong>Objective: </strong>The authors evaluated whether glucagon-like peptide-1 receptor agonists (GLP-1-RAs) improve outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH), spontaneous intracerebral hemorrhage (sICH), and acute ischemic stroke (AIS) and reduce the overall incidence of these events.</p><p><strong>Methods: </strong>This retrospective study leveraged TriNetX data (2014-2024) to identify patients with aSAH, sICH, or AIS. Individuals receiving exenatide, lixisenatide, semaglutide, dulaglutide, liraglutide, or tirzepatide within 8 weeks of diagnosis were propensity matched to controls. Outcomes (e.g., mortality, rebleeding/recurrence, seizures, hydrocephalus) were assessed at 6 and 12 months; the incidence rates of stroke types were examined at 1 and 2 years.</p><p><strong>Results: </strong>For aSAH patients, GLP-1-RA use at 6 months reduced rebleeding (OR 0.73, p = 0.003) and mortality (OR 0.41, p < 0.001) and at 1 year lowered cognitive deficits (OR 0.63, p = 0.034) and mortality (OR 0.39, p < 0.001). In sICH patients, GLP-1-RAs decreased hydrocephalus (OR 0.37, p = 0.005) and seizures (OR 0.56, p = 0.007) at 6 months, with persistent benefits at 1 year (hydrocephalus, OR 0.38, p = 0.007; seizures, OR 0.63, p = 0.018), alongside lower mortality (OR 0.45-0.40, both p < 0.001) and rebleeding (OR 0.70-0.69, both p < 0.001) rates. In AIS patients, mortality fell at 6 months (OR 0.27, p < 0.001) and 1 year (OR 0.44, p < 0.001), with reduced recurrence (OR 0.60, p < 0.001) and lower hydrocephalus (OR 0.32, p < 0.001) and seizure (OR 0.43, p < 0.001) rates at 6 months. At 1 year, GLP-1-RA users had lower incidence rates of SAH (OR 0.64, p = 0.001), ICH (OR 0.62, p < 0.001), and AIS (OR 0.82, p = 0.003), which were sustained at 2 years (ORs 0.77-0.87, all p < 0.05). Adverse events were similar.</p><p><strong>Conclusions: </strong>GLP-1-RAs were associated with improved survival and fewer complications across stroke subtypes, plus reduced hemorrhagic and ischemic stroke incidence. Prospective trials are warranted to confirm these observations.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225616","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 and contributing factors in medicolegal cases involving cranial surgery in Canada.","authors":"Sean Barry, Katherine Tourigny, Tricia Barry, Patricia J Finestone, Richard Liu, Jacqueline H Fortier, Anna MacIntyre, Gary Garber","doi":"10.3171/2025.5.JNS242939","DOIUrl":"https://doi.org/10.3171/2025.5.JNS242939","url":null,"abstract":"<p><strong>Objective: </strong>Neurosurgery is a high-risk specialty with a low margin of error, and neurosurgeons have a higher medicolegal risk than practitioners in many other specialties. The aim of this study was to provide a current medicolegal landscape of cranial surgery in Canada.</p><p><strong>Methods: </strong>In this retrospective descriptive study, the authors evaluated 10 years (2012-2021) of cranial neurosurgical data on closed legal actions, medical regulatory authority (College) cases, and hospital complaints against neurosurgeons that had been submitted to the Canadian Medical Protective Association (CMPA). Only cranial cases, even those involving ventriculoperitoneal shunt (VPS) placement or catheter or wire insertion in the brain, were eligible for study inclusion. Excluded cases were those involving pediatric patients and angiography, radiation, ultrasound, or percutaneous procedures.</p><p><strong>Results: </strong>Seventy-six cranial cases were included in the study. Neurosurgeons had a significantly higher medicolegal risk compared to that of the overall CMPA surgeon membership. Civil legal actions accounted for more than half of all the cranial cases. Fifty-four percent of cases involved postoperative complications, and 21% involved VPS placement. Communication issues were commonly named factors leading to a medicolegal complaint throughout the data.</p><p><strong>Conclusions: </strong>This is the first report on the Canadian experience of medicolegal cranial surgery cases. These cases most commonly involved tumor excision, VPS insertion, and decompressive craniectomy. The VPS cases were unexpectedly common and should be further investigated. A breakdown in communication was a major theme in the medicolegal data repository.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225625","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}