Journal of neurosurgery最新文献

{"title":"A new era in neurosurgery residency applications: the impact of preference signaling on the neurosurgical match.","authors":"Ryan S Chung, David J Cote, Robert G Briggs, Ishan Shah, Michelle Lin, Keiko M Kang, Angela Tang-Tan, David Gomez, Jonathon Cavaleri, Angela P Mihalic, John C Liu, Steven L Giannotta, William J Mack, Gabriel Zada","doi":"10.3171/2025.3.JNS2583","DOIUrl":"https://doi.org/10.3171/2025.3.JNS2583","url":null,"abstract":"<p><strong>Objective: </strong>Applications to neurosurgical residency programs have progressively increased, both in applicant numbers and programs applied to per applicant. The adoption of signaling, beginning with 8 signals in the 2022-2023 cycle and increasing to 25 in the 2023-2024 cycle, has the potential to improve the match process and reduce applicant costs. This study analyzed trends in the neurosurgery residency match from 2017 to 2024 to evaluate the impact of signaling.</p><p><strong>Methods: </strong>The Texas STAR (Seeking Transparency in Application to Residency) is a survey administered annually to US applicants following the match. Data included neurosurgery applicants from 2017 to 2024 and were categorized into pre-COVID-19 (2017-2020), COVID-19 (2021-2022), and signaling (2023-2024) cohorts. Applicant-reported characteristics associated with matching were assessed. For the 2023 and 2024 cycles, signal yield (interviews at signaled programs divided by total signals), signal-to-interview ratio (percentage of interviews at signaled programs), and nonsignal yield (interviews at nonsignaled programs divided by nonsignaled applications) were calculated. Comparative statistics and regression models were applied.</p><p><strong>Results: </strong>Among 418 applicants (127 from 2023-2024 with signaling data), those in recent cycles submitted fewer applications (73.9 pre-COVID-19 vs 74.7 COVID-19 vs 64.3 signaling, p = 0.01) and received fewer interview offers (24.7 vs 23.0 vs 18.9, p < 0.001). In the 2023-2024 cycles, matched applicants had more abstracts, posters, presentations (8.65 vs 9.58 vs 10.47, p < 0.001) and publications (5.78 vs 7.71 vs 7.91, p < 0.001), with fewer total applications (72.62 vs 75.03 vs 62.26, p < 0.001) and interviews offered (25.85 vs 23.40 vs 21.02, p = 0.004), compared with matched applicants from previous cycles. A multivariable model showed that fewer applications was associated with greater match likelihood for 2023-2024 applicants (OR 0.87, 95% CI 0.77-0.99). Signal yield (54.0% vs 19.1%, p < 0.001), signal-to-interview ratio (71.5% vs 38.0%, p < 0.001), and nonsignal yield (22.4% vs 8.6%, p = 0.02) were higher among matched applicants versus unmatched applicants in 2024. The signal-to-interview ratio increased for matched applicants from 2023 to 2024 (18.2% vs 71.5%, p < 0.001), while the nonsignal yield decreased (33.7% vs 22.4%, p = 0.005), in line with increases in number of signals.</p><p><strong>Conclusions: </strong>Signaling has changed the landscape of the neurosurgery residency match process, with fewer applications submitted and fewer interviews offered per applicant. Signals seemingly result in increased interview likelihood and may hone the selection process to more efficiently align applicant and program preferences.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663938","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. Expanding insights on conservative management of brain AVMs in the TOBAS registry.","authors":"Lan Li, Xiuhua Tian, Xiaoyan Guo","doi":"10.3171/2025.4.JNS25791","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25791","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663941","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":"Correlation between time to postoperative seizure onset and time to tumor progression in a cohort of adult-type diffuse gliomas with molecular characterization.","authors":"Minh P Nguyen, Poojan D Shukla, Anthony T Lee, Edward F Chang, Jacob S Young","doi":"10.3171/2025.3.JNS242802","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242802","url":null,"abstract":"<p><strong>Objective: </strong>Seizure is frequently a presenting symptom for patients with diffuse glioma, and seizures can remain common throughout the disease course. Patients can develop seizures despite resection, and the relationship among postoperative seizures, tumor genetics, and tumor progression is unclear. The aim of this study was to characterize the clinical and genetic factors associated with delayed postoperative seizures in adult patients who had undergone resection of diffuse gliomas and to investigate the relationship between time to seizure onset and progression-free survival (PFS).</p><p><strong>Methods: </strong>The authors performed a retrospective registry chart review of adults who had undergone resection of diffuse gliomas at a single institution up until 2020 and for whom targeted next-generation sequencing was available. Linear regression was used to model the relationship between time to postoperative seizure and time to tumor progression. Cox proportional hazards regression was performed to identify factors associated with time to postoperative seizures. Seizures within 72 hours of surgery were considered immediate postoperative seizures and were excluded from this study.</p><p><strong>Results: </strong>Five hundred thirty-one patients were identified and included in the study. Among these patients, 176 IDH-mutant and 355 IDH-wildtype gliomas were resected up until 2020. The median follow-up was 28.3 months. In the patients with IDH-mutant tumors, seizures that occurred at least 17 months after surgery were strongly correlated with tumor progression; for patients with IDH-wildtype tumors, this correlation occurred at least 2 months after surgery. Male sex, seizure at initial presentation, and MDM2 mutation were significantly associated with worse seizure-free survival in patients with IDH-wildtype gliomas, whereas the SETD2 mutation was associated with improved seizure freedom. In IDH-mutant glioma cases, a higher preoperative Karnofsky Performance Status and NIPBL mutation predicted longer seizure freedom. More than 12 months of postoperative seizure freedom was associated with improved PFS and overall survival regardless of IDH mutation status.</p><p><strong>Conclusions: </strong>The development of seizures after surgery might predict a risk of tumor progression if they occur beyond a postoperative period unique to IDH status. Specifically, an MDM2 mutation and presentation with seizures were strong predictors of tumor progression in glioblastoma (GBM). SETD2 and NIPBL mutations might predict greater seizure freedom in GBM and IDH-mutant gliomas, respectively.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663940","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":"Pituitary transposition techniques: surgical anatomy and technical nuances.","authors":"Yuanzhi Xu, Kumar Abhinav, Jonathan Rychen, Muhammad Reza Arifianto, Christine K Lee, Vera Vigo, Ahmed Mohyeldin, Aaron A Cohen-Gadol, Juan C Fernandez-Miranda","doi":"10.3171/2025.3.JNS242358","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242358","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The primary objective of this study was to elaborate on the surgical anatomy and technical nuances of pituitary transposition techniques and assess their clinical application, enhancing both the safety and efficacy of endonasal approaches to the retrosellar and interpeduncular regions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Twenty-two colored silicone-injected specimens were dissected stepwise via an endoscopic endonasal approach. A comprehensive assessment of pituitary transposition techniques, including anatomical landmarks, surgical nuances, and transposition distances, was performed. Their clinical relevance was presented using illustrative cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The following pituitary transposition techniques were established according to their relationship with the dual-layered sellar dura and the extent of pituitary gland mobilization: extradural (involves elevating the dura from the sellar floor, allowing limited access to the lower dorsum sellae and superior pituitary gland mobilization [mean vertical transposition distance ± SD of 2.4 ± 0.7 mm]); interdural transsellar (outer dural layer is incised at the sellar face and floor, improving access to the dorsum sellae and facilitating further superior pituitary gland mobilization [mean vertical transposition distances of 4.1 ± 0.8 mm at the midline and 4.9 ± 0.7 mm at the lateral aspect]); interdural transcavernous (outer dural layer is opened at the anterior wall of the cavernous sinus [CS] for superomedial pituitary gland mobilization with direct transcavernous access to the posterior clinoid process [mean vertical transposition distances of 3.6 ± 0.6 mm at the midline and 6.8 ± 0.7 mm at the lateral aspect, mean horizontal transposition distance of 3.8 ± 0.7 mm]); extended interdural transcavernous (interdural approach is extended into the clinoidal space by transecting the caroticoclinoid ligament, maximizing exposure for challenging posterior clinoidectomy [mean vertical transposition distances of 5.5 ± 0.9 mm at the midline and 8.7 ± 0.9 mm at the lateral aspect, mean horizontal transposition distance of 7.2 ± 0.8 mm]); intradural hemitransposition (involves opening both dural layers at the sellar face, dissecting the pituitary gland away from the medial wall of the CS on the selected side, and enabling ipsilateral paramedian exposure of the dorsum sellae and retrosellar and retroinfundibular regions); full intradural (pituitary gland is dissected away from the medial wall of the CS bilaterally, facilitating its horizontal and vertical mobilization and providing comprehensive access to the dorsum sellae and bilateral retrosellar and retroinfundibular regions; transection of the diaphragm enhances suprasellar access); and pituitary gland sacrifice (complete removal, offering unimpeded access to the retrosellar and retroinfundibular regions).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Seven pituitary transposition techniques based on dural opening, gla","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663942","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 role of reduced platelet function in postoperative intracranial bleeding among supratentorial severe spontaneous intracerebral hemorrhage patients on long-term antiplatelet therapy.","authors":"Yang Liu, Zheng Wen, Qingyuan Liu, Shuo Zhang, Kaiwen Wang, Shaohua Mo, Kaige Zheng, Shuo Wang, Jun Wu","doi":"10.3171/2025.3.JNS242411","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242411","url":null,"abstract":"<p><strong>Objective: </strong>Patients with severe spontaneous intracerebral hemorrhage on long-term oral antiplatelet therapy (SSICH-LOAPT) may be at high risk of postoperative intracranial bleeding (PIB). The effect of reduced platelet function (RPF) on PIB is unclear. This study aimed to investigate the relationship between RPF and PIB in patients with supratentorial SSICH-LOAPT and explore factors for risk stratification to predict PIB.</p><p><strong>Methods: </strong>The supratentorial SSICH-LOAPT patients receiving surgery were enrolled from a multicenter prospective cohort study. Preoperative platelet function was measured using thromboelastography and was categorized as RPF (kaolin maximum amplitude [CK-MA] < 50 mm) or non-RPF. The primary outcome was PIB within 7 days after surgery. The risk of PIB in RPF and non-RPF patients was compared.</p><p><strong>Results: </strong>This study included 172 supratentorial SSICH-LOAPT patients (126 male patients, median age 56 years). PIB occurred in 25 (14.5%) patients, and 6 (3.5%) patients experienced severe PIB, which required repeat surgery. Eighteen (10.5%) patients were identified as having RPF. Kaplan-Meier analysis revealed that patients with RPF exhibited a higher incidence of PIB compared with non-RPF patients (61.1% vs 9.1%, p < 0.001). After adjusting for age, intracerebral hemorrhage history, antiplatelet therapy regimen, coagulation dysfunction, and hematoma volume, RPF was independently associated with postoperative rebleeding (hazard ratio 5.24, 95% CI 1.29-21.33; p = 0.021). Patients who developed severe PIB had significantly lower CK-MA values (median 33.9 mm) compared to those with nonsevere PIB (median 50.2 mm) (p = 0.001).</p><p><strong>Conclusions: </strong>RPF was a risk factor related to PIB for supratentorial SSICH-LOAPT patients. Clinical trial registration no.: ChiCTR1900024406 (www.chictr.org.cn).</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663944","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":"Central thalamic deep brain stimulation for disorders of consciousness: an individual participant data meta-analysis.","authors":"David Bergeron, Karim Mithani, Marina Raguž, Darko Chudy, Yongzhi Huang, Aristides Hadjinicolaou, Christian Iorio-Morin, Marie-Pierre Fournier-Gosselin, Sami Obaid, George M Ibrahim, Alexander G Weil","doi":"10.3171/2025.3.JNS241092","DOIUrl":"https://doi.org/10.3171/2025.3.JNS241092","url":null,"abstract":"<p><strong>Objective: </strong>Severe traumatic brain injury, cerebral hemorrhage, or cardiac arrest can lead to disorders of consciousness, such as coma, unresponsive wakefulness syndrome, and minimally conscious state (MCS). Deep brain stimulation (DBS) of central thalamic nuclei has been used as therapy to restore consciousness and promote neurological recovery for these patients. It is difficult to evaluate the effectiveness of this emerging therapy given the small sample sizes of published studies and their methodological limitations.</p><p><strong>Methods: </strong>An individual participant data (IPD) meta-analysis was performed to assess neurological outcomes after central thalamic DBS for chronic disorders of consciousness. The authors systematically reviewed the existing literature in accordance with PRISMA guidelines. The lead authors for every published case or cohort receiving DBS for disorders of consciousness were contacted; data that included the clinical diagnosis and pre- and postoperative neurological status according to the JFK Coma Recovery Scale-Revised (CRS-R) were requested for the individual cases included in their papers. The results were pooled, and the influence of different factors (preoperative consciousness status, age, time from injury to DBS implantation, and anatomical target) on the neurological outcome after DBS implantation was analyzed.</p><p><strong>Results: </strong>IPD of 49 patients who underwent implantation with central thalamic DBS for chronic disorders of consciousness (37 in a vegetative state and 12 in MCS) from 7 distinct centers were analyzed. Overall, 7 of 49 patients significantly recovered awareness after DBS implantation, all of whom underwent implantation ≤ 12 months after neurological injury. The main predictors of greater CRS-R improvement were age at the time of surgery and the delay between injury and DBS implantation.</p><p><strong>Conclusions: </strong>In patients with severe impairments of consciousness, cyclic DBS of the central thalamus has acutely improved daytime awareness and could increase the potential for readaptation and recovery. However, in this IPD meta-analysis, insufficient data were found to suggest that central thalamic DBS significantly improves the natural history of neurological recovery in patients with chronic disorders of consciousness.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663939","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 role of Area Deprivation Index in treatment selection for anterior communicating artery aneurysms.","authors":"Rashad Jabarkheel, Avi A Gajjar, Najib Muhammad, Oliver Y Tang, Samuel B Tomlinson, Josh Golubovsky, Antonio Corral Tarbay, Georgios S Sioutas, Sai Mannam, Alex Vaz, Sonia Ajmera, Sandeep Kandregula, Bryan Pukenas, Omar Choudhri, Brian T Jankowitz, Jan-Karl Burkhardt, Visish M Srinivasan","doi":"10.3171/2025.4.JNS242291","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242291","url":null,"abstract":"<p><strong>Objective: </strong>Patient outcomes in medicine vary significantly when stratified by socioeconomic status (SES). In the cerebrovascular area specifically, rates of treatment of intracranial aneurysms (IAs) and overall outcomes after subarachnoid hemorrhage vary significantly by SES. Less is known about the effect of SES on the selection of seemingly equivocal treatment modalities (microsurgery vs endovascular embolization) for IAs. In this study, the authors examined the impact of SES as measured by the Area Deprivation Index (ADI) on selection of the treatment modality for anterior communicating artery (ACoA) aneurysms, which are readily amenable for either microsurgical or endovascular treatment.</p><p><strong>Methods: </strong>A retrospective study was conducted on 136 consecutively treated patients with ACoA aneurysms, unruptured and ruptured, between August 2016 and February 2023 at a large, urban, academic hospital led by dual-trained neurosurgeons. A retrospective review of patient demographics, comorbidities, aneurysm size, morphology, and treatment selection was performed. Univariable and multivariable logistic regression analysis of treatment selection was conducted in the unruptured context, an elective setting, where socioeconomic factors play a strong role in patient-provider shared decision-making, versus the ruptured context, an emergency setting, where the need for expedient intervention diminishes the weight of socioeconomic considerations.</p><p><strong>Results: </strong>Multivariable logistic regression showed that being a patient in the top 50th ADI percentiles was strongly associated with undergoing microsurgical treatment of an ACoA aneurysm in the unruptured context (OR 10.88, 95% CI 1.37-86.59; p = 0.02). Conversely, in the context of ruptured ACoA aneurysms, ADI was not associated with treatment selection (OR 0.16, 95% CI 0.02-1.27; p = 0.08).</p><p><strong>Conclusions: </strong>ADI significantly impacts treatment selection in the management of unruptured ACoA aneurysms. This study highlights that there might be indirect socioeconomic barriers biasing patients from lower SES backgrounds away from endovascular treatment of unruptured ACoA aneurysms compared with their higher SES counterparts.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663943","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":"Neurosurgical faculty and resident perspectives on collective bargaining efforts by resident physicians in the United States.","authors":"Prateek Agarwal, Mark M Zaki, Rohit Prem Kumar, Maria A Eckmann, William H Shuman, Owoicho Adogwa, Omar A Zalatimo, Clemens M Schirmer, Gregory J Zipfel, Nathan R Selden, John K Ratliff, Russell R Lonser, Katie O Orrico, E Antonio Chiocca","doi":"10.3171/2025.3.JNS243068","DOIUrl":"https://doi.org/10.3171/2025.3.JNS243068","url":null,"abstract":"<p><strong>Objective: </strong>Collective bargaining unions frequently represent employees across industries, including healthcare workers such as nurses. In recent years, resident physicians have been increasingly unionizing to improve working conditions and benefits. However, whether resident unionization will benefit or harm neurosurgery training is unclear. This study aimed to ascertain the perspectives of neurosurgical faculty and trainees on collective bargaining efforts by resident physicians in the United States.</p><p><strong>Methods: </strong>A 17-question survey (14 multiple choice, 3 open ended) evaluating respondents' opinions on resident unionization was emailed to lists of 551 faculty members and 1728 neurosurgical trainees (residents and fellows) in the United States. Both lists were extracted from a database maintained by the Society of Neurological Surgeons (SNS). The faculty list consisted of department chairs, residency program directors, and members of the SNS. Categorical variables were analyzed using chi-square tests. All p values < 0.05 were considered significant.</p><p><strong>Results: </strong>There were 405 respondents (17.8% response rate): 182 faculty (33.0%) and 223 trainees (12.9%). Among faculty respondents, 70% opposed or strongly opposed unions, 54% thought they negatively impact patient care, 80% thought they could lead to strikes, and 85% thought alternate channels for voicing resident concerns were adequate. In contrast, among trainees, only 16% opposed or strongly opposed unions, 9% thought they negatively impacted patient care, 27% thought they could lead to strikes, and 38% thought alternate channels for voicing resident concerns were adequate (all p < 0.001). Among institutions with resident unions, 34.2% of faculty and 12.1% of trainees indicated witnessing a negative consequence of unionization, frequently mentioning an inability to make departmental-level changes without applying changes to all resident specialties. Among unionized residents, 84.8% reported a positive result of unionization, including improved pay, protected working hours, parental leave, parking, and educational stipends.</p><p><strong>Conclusions: </strong>The findings revealed a divide between the opinions of trainees and faculty about trainee unionization. Trainees favored resident unionization, while faculty opposed it, highlighting the need for further dialogue to understand the impact of unions on residency training and promote optimal training environments in both unionized and nonunionized environments.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612200","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":"Minimally invasive surgical evacuation confers a mortality benefit in patients with moderate-sized putaminal hemorrhages.","authors":"Ahmed Kashkoush, Daniel T Lilly, Robert Winkelman, Mark A Davison, Rebecca Achey, Muhammad Shazam Hussain, Joao Gomes, Peter A Rasmussen, Varun R Kshettry, Nina Moore, Mark Bain","doi":"10.3171/2025.3.JNS2565","DOIUrl":"https://doi.org/10.3171/2025.3.JNS2565","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive surgical (MIS) evacuation of basal ganglia hemorrhages has not demonstrated efficacy compared with medical management. Prior study from this group has suggested that MIS evacuation of moderate-sized putaminal intracranial hemorrhages (pICHs) using tubular retractors is associated with favorable functional outcomes. The authors hypothesized that postoperative functional outcomes were improved in patients with moderate-sized pICH compared with those of a matched cohort of medically managed patients.</p><p><strong>Methods: </strong>The authors performed a single-center retrospective review of patients admitted with non-lesional pICH between 10 and 50 mL from 2013 to 2024. Patients who underwent MIS evacuation were 1:1 matched to medically managed patients based on volume and ICH score. The main outcome was the utility-weighted modified Rankin Scale (uw-mRS) score obtained within 1 year of admission. Regional pICH extension patterns were evaluated by stereotactically localizing pICH volumes in an anatomical coordinate frame.</p><p><strong>Results: </strong>Sixty-six patients (33 medical and 33 surgical) were included. The uw-mRS score was similar in the medical and surgical cohorts (mean 0.33 vs 0.44, p = 0.174). Mortality was higher in the medically managed group (24% [medical] vs 3% [surgical], p = 0.010). The median ICU length of stay (LOS) was 3 days shorter in the surgical arm (7 vs 4 days, p = 0.045). Anteromedial extension in the region of the anterior limb of the internal capsule and caudate predicted poor outcome (mRS scores 4-6) in surgically managed patients (area under the curve [AUC] 0.74, p = 0.006), while posterior and superior extension in the region of the frontal lobe predicted poor outcomes in medically managed patients (AUC 0.74, p = 0.045). The incremental cost-effectiveness ratio was $68,462.55 per quality-adjusted life year for surgical evacuation compared with medical management.</p><p><strong>Conclusions: </strong>In this study, MIS evacuation of moderate-sized pICHs was associated with improved mortality rates, shorter ICU LOS, and cost-effectiveness. Putaminal ICH morphology can differentially predict functional outcome based on management strategy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612198","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":"Stratification of glioblastoma patient survival based on tumor core and edge metabolomic data.","authors":"Dylan A Goodin, Hunter A Miller, Xinmin Yin, Xiang Zhang, Joseph Chen, Brian J Williams, Hermann B Frieboes","doi":"10.3171/2025.3.JNS242330","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242330","url":null,"abstract":"<p><strong>Objective: </strong>Spatial metabolic differences recently found in glioblastoma (GBM) have been linked to the infiltrating nature of the tumor edge tissue, which is mostly unresectable, and to the tumor core tissue, which resists therapy. The impact of metabolic dysregulation in core and edge GBM tissues on patient survival remains unclear. This study evaluated metabolites obtained from core and edge GBM tissues at the time of resection as biomarkers to risk stratify patients in terms of overall survival (OS).</p><p><strong>Methods: </strong>Paired core and edge tumor samples from 27 patients with glioma obtained after craniotomy were evaluated postsurgery with high-resolution 2D liquid chromatography-mass spectrometry/mass spectrometry, and metabolomic data for grade IV samples (n = 21) were analyzed by Kaplan-Meier survival analysis and univariable and multivariable Cox proportional hazard regression models. GBM patients were stratified into low- and high-risk groups via a linear equation based on log-transformed signal intensities of key metabolites. Risk scores were generated by summing the product of weights and metabolite signal intensities for each patient's tumor. Weights for significant metabolites were calculated by scaling the univariable Cox proportional hazard ratio for each metabolite by the standard error. For risk score validation, OS events were predicted using an Extreme Gradient Boosting model with Linear Booster (XGBL).</p><p><strong>Results: </strong>Kaplan-Meier survival analysis identified 6 significant metabolites in core tissue and 5 in edge tissue, respectively. Key metabolites in core and edge tissue identified through univariable Cox regression analyses combined with covariates were used to generate multivariable Cox regression models, with edge metabolites remaining significant after correction by patient sex and age at resection. Risk scores based on either 4 core or 11 edge metabolites, or the combination of both, with covariates, generated multivariable Cox regression models significantly associated with OS. Risk score derived from core metabolites remained significant after correction by covariates and was validated with XGBL classification model (area under the receiver operating characteristic curve = 0.876).</p><p><strong>Conclusions: </strong>OS of patients with GBM can be stratified based on metabolomic differences between core and edge tumor tissues.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612202","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}