Journal of neurosurgery最新文献

{"title":"Surgical implications of BRAF V600E-positive Rathke's cleft cysts: prediction of early recurrence based on reclassification to papillary craniopharyngioma.","authors":"Loke Yuan Shee, Xing Liu, Zisu Zhai, Jintian Xu, Songbai Gui, Lei Cao","doi":"10.3171/2025.12.JNS251886","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251886","url":null,"abstract":"<p><strong>Objective: </strong>Rathke's cleft cysts (RCCs) and craniopharyngiomas (CPs) are lesions of the sellar region, both originating from remnants of Rathke's diverticulum. The presence of squamous metaplasia (SM) within RCCs often creates histological overlaps with papillary CPs (PCPs), complicating accurate diagnosis. Given the distinct treatment and clinical outcomes associated with these lesions, precise identification is essential. BRAF V600E and CTNNB1 mutations have emerged as distinguishing genetic markers for PCP and adamantinomatous CP (ACP), respectively. This study aimed to evaluate the utility of BRAF V600E and β-catenin immunohistochemistry in differentiating RCC from CP.</p><p><strong>Methods: </strong>The authors retrospectively reviewed the clinical, radiological, and histopathological data of 383 RCCs diagnosed between January 2015 and May 2024 at Beijing Tiantan Hospital. BRAF V600E and CTNNB1 immunohistochemistry were performed on all cases, with BRAF results confirmed via Sanger sequencing. Clinical outcomes were evaluated during follow-up.</p><p><strong>Results: </strong>Sixty-nine RCC cases met the inclusion criteria (61 primary and 8 recurrent). Of these, 52 cases were in intrasellar region (75.4%), with 9 cases (13.0%) in the suprasellar region and 8 cases (11.6%) involving both regions. Histologically, 39 cases (56.5%) exhibited epithelial SM. No nuclear β-catenin accumulation localization was detected. BRAF V600E expression was observed in 7 cases (10.1%), all within areas of SM, and confirmed with Sanger sequencing. These positive cases also showed elevated Ki-67 indices, with proliferative activity concentrated at the basal layer of the epithelium with SM. Based on these molecular and histological findings, the 7 BRAF V600E-positive cases were reclassified as PCPs. Notably, Kaplan-Meier analysis demonstrated significantly worse progression-free survival in BRAF V600E-positive cases compared to wild-type cases (p = 0.023).</p><p><strong>Conclusions: </strong>BRAF V600E and CTNNB1 mutation analysis is a valuable diagnostic tool for distinguishing RCC from CP. Given the potential for RCC to transform into PCP, the authors recommend BRAF V600E testing for all RCC cases. For BRAF V600E-positive cases, close monitoring of tumor progression or adjuvant therapies is advised.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856590","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":"Intractable epilepsy before and/or after awake functional mapping-based surgery for IDH-mutant grade 2 glioma: a consecutive series of 105 patients.","authors":"Sam Ng, Hugues Duffau","doi":"10.3171/2025.12.JNS251916","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251916","url":null,"abstract":"<p><strong>Objective: </strong>Awake resection in grade 2 glioma (G2G) improves quality of life (QOL) and overall survival (OS). Nonetheless, epilepsy occurs frequently in this context and can impair QOL, especially when the disorder is pharmacoresistant. Herein, the goal was to study patients with intractable epilepsy (IE) before and/or after surgery for a G2G.</p><p><strong>Methods: </strong>Patients who underwent awake functional mapping-based resection of an IDH-mutant G2G in the period from June 2002 to March 2024 and had IE before and/or after surgery (follow-up > 1 year) were selected for this retrospective study. Onco-functional outcomes were compared among patients with preoperative IE who were completely seizure free (Engel class IA) postoperatively (group 1), patients with preoperative and postoperative IE (group 2), and patients who experienced IE only postoperatively (group 3).</p><p><strong>Results: </strong>In a consecutive series of 105 patients (61 males [58.1%]) with a mean age of 35.6 ± 12.2 years, 134 awake surgeries were performed. At diagnosis, 101 patients (96.2%) presented with seizures, and 82 patients (78.1%) presented with IE. The mean preoperative Karnofsky Performance Status (KPS) was 88.7 ± 7.4, and 74 patients (70.5%) were able to work preoperatively. Sixty-three gliomas (60%) were left-sided and 42 were right-sided, which consisted of 66 insula-centered/paralimbic (62.8%), 13 central (12.4%), 14 frontal (13.3%), 6 temporal (5.7%), and 6 parietal (5.7%) tumors. The mean preoperative tumor volume was 82.8 ± 47.9 cm3. Only 1 patient (0.9%) had persistent postoperative deterioration, and the mean postoperative KPS was 89.2 ± 6.4. Sixty-one patients returned to work (82.4%). The mean extent of resection (EOR) was 86.8% ± 8.3% (mean residual volume 13 ± 18.4 cm3). Histopathologically, there were 65 astrocytomas (61.9%) and 40 oligodendrogliomas (38.1%). Twenty-two patients (21.0%) had immediate adjuvant therapy, and 29 patients (27.6%) underwent reoperation(s). The mean follow-up was 8.3 ± 4.7 years with an OS rate of 70.5%. Sixty patients (57.1%) were completely seizure free after surgery (group 1), and 45 patients (42.8%) had postoperative IE (22 patients [21.0%] in group 2 and 23 patients [21.9%] in group 3). The proportion of insula-centered/paralimbic G2Gs was higher in group 1 (p = 0.002), whereas the percentage of central G2Gs was greater in groups 2 and 3 (p = 0.01). Higher preoperative tumor volume (p < 0.00001) and lower EOR (p = 0.05) were correlated to IE. The postoperative KPS (p < 0.00002) and return to work (RTW) rate (p = 0.0004) were higher in group 1.</p><p><strong>Conclusions: </strong>These original findings show that G2G location, tumor volume, and EOR are associated with perioperative IE, itself correlated to QOL, especially KPS and RTW. Such data may help neurosurgeons better evaluate the epilepto-onco-functional balance of surgery in G2G.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856499","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":"Long-term outcomes of Gamma Knife surgery for vestibular schwannomas: tumor stability supports reduced surveillance after 10 years.","authors":"Toshinori Hasegawa, Takenori Kato, Akihiro Mizuno, Takehiro Naito, Yuto Ando, Naofumi Kosaka","doi":"10.3171/2025.12.JNS252098","DOIUrl":"https://doi.org/10.3171/2025.12.JNS252098","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of this study was to evaluate the long-term efficacy and safety of Gamma Knife surgery (GKS) for sporadic vestibular schwannoma (VS), focusing on the durability of tumor control and the necessity of extended posttreatment imaging surveillance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective study included patients with sporadic VS treated with single-session GKS between May 1991 and January 2020 at a single center. Tumors were classified into the following anatomical types using a modified Koos-based system: type A (intracanalicular), type B (cerebellopontine angle), type C (mild brainstem compression), and type D (severe brainstem compression with fourth ventricle deviation). A subgroup analysis in patients without salvage treatment within the first 5 years after GKS and with ≥ 5 years of follow-up was performed to assess long-term stability. Salvage treatment rates, functional outcomes, and adverse events were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 878 patients (488 female, median age 57 years) with sporadic VS treated with single-session GKS were included in the analysis. A subgroup of 793 patients (438 female, median age 58 years) remained free of salvage treatment during the first 5 years after GKS and had ≥ 5 years of follow-up. The median clinical follow-up duration was 154.5 months. Salvage treatment was required in 7.5% of the patients, with a significantly higher incidence in patients with type D tumors (24.7% at 5 years) compared with type A-C tumors (3.6%) (subdistribution hazard ratio 2.319, p = 0.036). In the subgroup of patients with stable disease, the cumulative incidence of salvage treatment at 15 years was 2.1%, and true tumor progression was identified in only 2 patients (0.3%). Notably, tumor type at the time of GKS did not significantly influence the risk of salvage treatment beyond 5 years in the subgroup. Serviceable hearing preservation improved in more recent treatment periods: patients with pre-GKS Gardner-Robertson class 1 hearing had a 10-year preservation rate of 63% in the late treatment period (2005-2023) compared with 48% in the early period (1991-2004). Among late adverse events, cyst-related complications were the most common (3.1%), whereas trigeminal neuralgia (1.6%), persistent facial palsy (0.1%), and malignant transformation (0.2%) were infrequent.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;GKS provided durable long-term tumor control and functional preservation in patients with small- to medium-sized VS. True tumor progression beyond 10 years was not observed in this cohort, suggesting that the intensity or frequency of routine imaging surveillance can be reduced or individualized after 10 years in patients with stable disease during the first 5 years after GKS. However, because delayed adverse events (e.g., cyst formation, trigeminal neuralgia, and malignant transformation) can still occur, follow-up strategies should be tailored according to initial tumor c","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856460","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":"Maximum safe resection of insular gliomas: update on surgical outcomes from 500 cases.","authors":"Jacob S Young, Nadeem N Al-Adli, Daniel Quintana, Grazia Menna, Jasper K W Gerritsen, Jing Li, Ramin A Morshed, Shawn L Hervey-Jumper, Mitchel S Berger","doi":"10.3171/2025.12.JNS251889","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251889","url":null,"abstract":"<p><strong>Objective: </strong>Insular gliomas present a unique surgical challenge due to their location near critical vascular structures and proximity to functional brain regions. While different surgical approaches to insular tumors exist, language and motor stimulation mapping are critical for a transcortical approach. The aim of this study was to determine if the transcortical approach to resection of insular gliomas remains a safe and effective strategy by assessing tumor characteristics, surgical outcomes, and postoperative functional outcomes in patients with newly diagnosed or recurrent tumors.</p><p><strong>Methods: </strong>This retrospective analysis included 502 newly diagnosed and recurrent low-grade gliomas (LGGs) and high-grade gliomas (HGGs) of the insula (in 394 unique patients) resected between September 1997 and December 2022 at a single center. Tumors were classified based on the Berger-Sanai zone schema, and contrast-enhancing and non-contrast-enhancing tumor volumes were manually segmented on MRI and used to calculate the extent of resection (EOR). Patient morbidity was assessed at multiple time points from the initial presentation to at least 6 months of follow-up. Progression-free survival (PFS) and overall survival (OS) were compared between subgroups using unadjusted and propensity score-adjusted Kaplan-Meir and Cox regression analyses.</p><p><strong>Results: </strong>Overall, 316 (165 LGG, 151 HGG) newly diagnosed and 186 (69 LGG, 117 HGG) recurrent cases were included. Grade 2 gliomas were typically larger than grade 4 IDH-wildtype gliomas (43 cm3 vs 17.5 cm3, p < 0.001). Persistent postoperative motor and language deficits occurred in < 4% of cases with newly diagnosed grade 2 tumors, although transient deficits occurred more frequently (9.5% of cases with transient motor deficit and 20% of cases with transient language deficit). For patients with newly diagnosed grade 2 insular gliomas, OS was improved when the residual tumor volume was < 2.7 cm3. Minimizing residual tumor volume was also associated with prolonged PFS and OS for recurrent grade 2 insular gliomas. Similarly, contrast-enhancing tumor EOR > 88.6% was associated with improved PFS and OS for patients with newly diagnosed IDH-wildtype glioblastoma. Overall, surgical and medical complications occurred in < 3% of cases. Finally, new permanent arm or leg weakness was significantly associated with worse OS in multivariable analyses (HR 2.06, 95% CI 1.14-3.74; p = 0.017).</p><p><strong>Conclusions: </strong>Maximum safe resection using a transcortical approach and cortical and subcortical mapping continues to be a robust surgical strategy with low surgical morbidity for patients with newly diagnosed and recurrent insular gliomas.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":3.6,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856440","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":"Subgaleal versus white matter reference for stereo-electroencephalography recordings: comparison of clinical impact and signal quality.","authors":"Davin Devara, Zahra Jourahmad, Danika L Paulo, Mohammed Hasen, Ryan Jafri, Joshua Adkinson, Layth S Mattar, Raissa K Mathura, Zain U Naqvi, Tommy Liu, Jonathan H Bentley, Kasra Mansourian, Thomas Hamre, Sarah Soubra, Alica M Goldman, Lu Lin, Vaishnav Krishnan, Benjamin Y Hayden, Kalman A Katlowitz, Sarah Heilbronner, Nicole R Provenza, Sameer A Sheth, Andrew J Watrous, Eleonora Bartoli","doi":"10.3171/2025.12.JNS251675","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251675","url":null,"abstract":"<p><strong>Objective: </strong>Stereo-electroencephalography (sEEG) is a common method for clinical epilepsy monitoring and provides unique opportunities for intracranial research in humans. Optimal selection of reference electrodes is essential for obtaining high-quality localizable data. White matter (WM) electrode contacts are commonly used as references; however, this reference scheme presents several limitations that may influence the data, including a limited selection of electrodes in the WM, nonneutral activity in the WM, and a laterality bias. Here, the authors detail the use of a midline subgaleal (SG) electrode as an alternative reference for sEEG recordings.</p><p><strong>Methods: </strong>An SG reference was used for 14 patients with drug-resistant epilepsy undergoing intracranial monitoring. Following the placement of sEEG electrodes, one 8-contact sEEG electrode (n = 2) or 4-contact strip electrode (n = 12) was placed in the SG space at the parietal midline. In a subset of 4 participants, we obtained awake, resting baseline recordings (5-minute duration) using different references, allowing us to compare signals recorded with an SG, WM, and gray matter (GM) reference. The authors compared the number of interictal spikes (IISs) detected by measuring the seizure onset zone selectivity index (SSI), cross-channel correlations, and power spectral density properties across these baseline recordings.</p><p><strong>Results: </strong>No adverse effect of the SG electrode placement was reported in any participant. Recordings using an SG reference have a higher SSI compared with a WM or GM reference. Neural signals obtained with an SG reference have lower cross-channel correlations compared with the other two references and preserve more power at higher frequencies than a WM or GM reference.</p><p><strong>Conclusions: </strong>Extracranial placement of an SG electrode allows for a neutral midline reference. The authors' findings demonstrate that an SG reference is a safe alternative to the standard WM reference, improving the signal-to-noise ratio and not interfering with the clinical investigation.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816355","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":"Adamantinomatous craniopharyngioma: outcomes from a US multicenter registry cohort (RAPID consortium study).","authors":"Yuki Shinya, Sandhya R Palit, Maria Peris Celda, Andrew S Little, Mark A Pacult, Paul Gardner, Georgios Zenonos, James Evans, Juan Fernandez-Miranda, Adam Mamelak, Robert C Rennert, William T Couldwell, Gabriel Zada, Albert H Kim, Julie M Silverstein, Won Kim, Marvin Bergsneider, Kyle C Wu, Daniel M Prevedello, Nathan Zwagerman, Stephanie Cheok, Michael P Catalino, Varun R Kshettry, Michael Karsy, Jamie J Van Gompel","doi":"10.3171/2025.12.JNS252065","DOIUrl":"https://doi.org/10.3171/2025.12.JNS252065","url":null,"abstract":"<p><strong>Objective: </strong>Adamantinomatous craniopharyngioma (ACP) is a rare type of brain tumor that affects a wide age range, from children to older adults. Due to the rarity of the disease, existing studies are predominantly limited to single-center or single-surgeon experiences, often lacking statistical power and generalizability. The aim of this study was to address this gap by providing a comprehensive analysis of ACP outcomes based on a large multicenter cohort from the Registry of Adenomas of the Pituitary and Related Disorders (RAPID).</p><p><strong>Methods: </strong>This multicenter retrospective cohort study was conducted via the RAPID consortium and assessed patients with histologically confirmed ACP treated surgically between August 2000 and November 2024 at high-volume pituitary centers across the United States.</p><p><strong>Results: </strong>Among the 359 patients (206 male, median age at primary surgery of 47 years) included in the analysis, 76% underwent endoscopic transsphenoidal surgery and 22% underwent craniotomy. Gross-total resection was achieved in 45% and subtotal resection in 47%. Notably, 120 of 311 patients (39%) presented with preoperative hypothalamic-pituitary axis dysfunction. Following all treatments, permanent hypothyroidism was reported in 40% of patients, adrenal insufficiency in 33%, and arginine vasopressin deficiency in 19%. Of 263 patients who underwent primary surgery, radiation therapy was administered in 84 (32%). Progression-free survival (PFS) declined from 66% at 1 year to 31% at 6 years. In the multivariable analysis, independent predictors of worse PFS included subtotal resection (HR 0.22, 95% CI 0.11-0.42; p = 0.001), partial resection (HR 0.11, 95% CI 0.04-0.28, p = 0.001), larger tumor size (HR 0.77, 95% CI 0.64-0.94; p = 0.009), and tumor extension beyond the sella and suprasellar regions (HR 0.21, 95% CI 0.06-0.74; p = 0.016). Primary surgery and salvage surgery groups showed comparable PFS.</p><p><strong>Conclusions: </strong>In this large multicenter cohort study, gross-total resection was achieved in fewer than half of patients and was independently associated with improved PFS. Approximately one-third of patients underwent radiation therapy after primary surgery. These findings provide robust evidence supporting the prognostic value of extent of resection and inform contemporary treatment algorithms for ACP. The high incidence of postoperative endocrinopathy underscores the need for individualized multidisciplinary long-term care. While the retrospective design is a limitation, the multicenter approach enhances the generalizability of these results.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816229","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. Intrathalamic gene delivery.","authors":"Rrita Daci, Terence R Flotte, Oguz I Cataltepe","doi":"10.3171/2026.2.JNS253163","DOIUrl":"https://doi.org/10.3171/2026.2.JNS253163","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816258","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":"Subthalamic nucleus deep brain stimulation in Meige syndrome: mapping the optimal stimulation sites and network targets.","authors":"Wentao Zheng, Chen Wang, Xi Chen, Qingpei Hao, Zihao Zhang, Yukui Li, Zhangyu Li, Jianyao Mao, Sifang Chen, Guowei Tan, Li Zhong, Ruen Liu","doi":"10.3171/2025.12.JNS251548","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251548","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to identify the optimal stimulation sites for subthalamic nucleus (STN) deep brain stimulation (DBS) in treating Meige syndrome using long-term follow-up data from a large sample cohort, evaluate the whole-brain functional connectivity patterns associated with favorable treatment responses, and validate these findings in an independent cohort.</p><p><strong>Methods: </strong>The authors retrospectively analyzed long-term outcomes in 65 patients with Meige syndrome who underwent bilateral STN-DBS in two centers. The local stimulation effects within the STN and the distributed functional connectivity associated with motor improvement were investigated using advanced imaging and modeling tools, including the Lead-Group Toolbox, DBS Sweet Spot Mapping Explorers, and DBS Network Mapping Explorers. To ensure the model's reliability and generalizability, both internal validation through multiple cross-validation strategies and external validation using independent cohorts were conducted.</p><p><strong>Results: </strong>STN-DBS yielded significant and sustained motor improvements in both cohorts, with mean Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) movement score reductions of 63% in the training cohort (n = 50) and 56% in the validation cohort (n = 15) (p < 0.001). At the local level, the optimal stimulation sites were consistently located in the dorsolateral sensorimotor subregion of the STN, extending bilaterally toward the associative subregion and centered at MNI coordinates x = ±12, y = -13, z = -6. At the network level, favorable outcomes were primarily associated with positive functional connectivity to the cerebellum and negative connectivity to the somatosensory cortex. Both the sweet spot and connectivity models developed using the training cohort showed significant correlations with clinical outcomes in the independent validation cohort (R = 0.59, p = 0.020; R = 0.74, p = 0.002, respectively) and remained robust across different cross-validation strategies.</p><p><strong>Conclusions: </strong>The optimal therapeutic efficacy of STN-DBS for Meige syndrome depends on precise targeting within the dorsolateral STN and modulation of a distributed functional network involving the cerebellum and sensorimotor cortex. These findings may aid in developing personalized targeting strategies and adaptive programming paradigms, ultimately improving the therapeutic efficacy of DBS in this challenging disorder.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816392","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 the Neurosurgery Research & Education Foundation skull base course on academic and career outcomes.","authors":"Kara A Parikh, Mustafa Motiwala, Emal Lesha, John E Dugan, Sean M Himel, L Madison Michael, Jacques J Morcos, Nickalus R Khan","doi":"10.3171/2025.12.JNS251234","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251234","url":null,"abstract":"<p><strong>Objective: </strong>Since 2010, the Neurosurgery Research & Education Foundation (NREF) has offered a Skull Base for Senior Residents course, using didactic sessions and cadaveric dissections to teach senior neurosurgery residents the basics of skull base surgery. In this paper, the impact of this course on the careers of previous attendees was evaluated.</p><p><strong>Methods: </strong>A list of attendees between 2010 and 2023 from the NREF Skull Base for Senior Residents course was obtained and data were collected for each attendee, including demographic information, career advancement, and academic productivity. Outcomes included advancing into a skull base neurosurgery fellowship and career, clinical practice setting, academic professorship appointment, and academic productivity as measured by publication count and the h-index. A survey of participants was also collected to assess the perceived individual benefit of participation in the course.</p><p><strong>Results: </strong>From 2010 to 2023, 203 US neurosurgery residents attended the NREF Skull Base for Senior Residents course. Of all attendees, 174 have graduated from residency, with 95 (54.6%) of these graduates pursuing careers in complex cranial surgery. Of the 174 graduates, 94 (54.0%) practice in an academic neurosurgery setting and 83 (88.3%) of the 94 have academic appointments. More past participants completed skull base fellowships (n = 59) and practice skull base neurosurgery (n = 73) than any other single neurosurgical subspecialty. The mean (± SD) number of publications after the course and total h-index by the participants were 29.4 ± 56.1 and 10.8 ± 9.4, respectively. The mean number of literature citations after the course was 434.5 ± 929.8.</p><p><strong>Conclusions: </strong>The majority of young neurosurgeons who attend the NREF Skull Base for Senior Residents course pursue academic neurosurgery careers across the US, with more choosing to pursue fellowships and jobs in a skull base subspecialty compared to choosing any other subspecialty. This finding highlights the career trajectory of participants and the utility of relevant subspecialty training to hone skills and foster growth in the careers of young skull base surgeons.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816225","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":"Risks associated with ventriculomegaly and symptomatic communicating hydrocephalus following stereotactic radiosurgery for vestibular schwannoma.","authors":"Megan M J Bauman, Samantha M Bouchal, Ramin A Morshed, Jamie J Van Gompel, Maria Peris Celda, Paul D Brown, Bruce E Pollock, Michael J Link","doi":"10.3171/2025.12.JNS25176","DOIUrl":"https://doi.org/10.3171/2025.12.JNS25176","url":null,"abstract":"<p><strong>Objective: </strong>Communicating hydrocephalus may occur following stereotactic radiosurgery (SRS) for vestibular schwannomas (VSs), yet identifying individual patient risk factors associated with this post-SRS complication remains a challenge. This study examined predictors of nonobstructive ventricular enlargement and symptomatic communicating hydrocephalus following primary SRS treatment for VS via a single-center institutional cohort review and meta-analysis of the literature.</p><p><strong>Methods: </strong>A retrospective single-institution cohort study and systematic literature review and meta-analysis examining post-SRS communicating hydrocephalus in VS was performed.</p><p><strong>Results: </strong>The institutional cohort consisted of 634 patients who received primary SRS as treatment for VS. The cohort was 51.6% female, with a median age of 64 (range 18-89) years. Following SRS treatment, 364 patients (57.4%) experienced tumor shrinkage, 218 (34.4%) had no change in the size of their lesion, and 52 (8.2%) experienced tumor growth. Nonobstructive ventricular enlargement was observed in 23 patients (3.6%) following SRS treatment, of whom 9 (39.1%) remained asymptomatic and 14 (60.9%) required placement of a ventriculoperitoneal (VP) shunt, with a median time to shunt placement of 8 months. In the multivariate analysis, patients ≥ 65 years old (p = 0.038), SRS target volume ≥ 5 cm3 (p < 0.001), maximum SRS dose ≥ 26 Gy (p = 0.015), and tumor growth at the most recent follow-up (p = 0.002) were associated with an increased risk of post-SRS ventricular enlargement. Similarly, patients with older age (p = 0.049), increased SRS target volume (p = 0.002), and tumor growth (p = 0.016) were at an increased risk of symptomatic communicating hydrocephalus requiring VP shunt placement. Twenty-nine studies, including the cohort in this study, met inclusion criteria in the meta-analysis. Of the pooled 7825 patients, the overall incidence of hydrocephalus following SRS was 5%, and a subanalysis of 7081 patients demonstrated the incidence of symptomatic hydrocephalus requiring a VP shunt to be 4%. In this subanalysis, the overall shunting rate in patients who experienced post-SRS ventriculomegaly was 92%. Among individual studies in the literature, increased tumor size was most commonly found to be a statistically significant risk factor for post-SRS hydrocephalus.</p><p><strong>Conclusions: </strong>Approximately 5% of patients may experience nonobstructive ventricular enlargement following primary SRS treatment for VS. However, not all patients may be symptomatic and require shunting. Patients who are older (≥ 65 years), those with larger tumor volumes, and those with post-SRS tumor growth may be at increased risk of communicating hydrocephalus and may benefit from closer clinical monitoring.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816230","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}