Journal of neurosurgery最新文献

{"title":"Spatial localization patterns in MRI-negative Cushing disease: a comparative pituitary heat map analysis.","authors":"Richard J Chung, Oumou Kalsoum Mbacke, Xue Feng, Georgios A Maragkos, Jonathan Yun, Kristine Ravina, Tanvika Vegiraju, M Beatriz Lopes, John A Jane, Michael P Catalino","doi":"10.3171/2026.5.JNS252620","DOIUrl":"https://doi.org/10.3171/2026.5.JNS252620","url":null,"abstract":"<p><strong>Objective: </strong>MRI-negative Cushing disease is challenging to treat due to difficulty with tumor localization and lower biochemical remission rates. Surgeons primarily rely on visual and tactile feedback to identify abnormal pituitary tissue. In this study, the authors analyzed intraoperative sketches of histology-confirmed corticotroph adenomas to compare the spatial distributions of MRI-positive and MRI-negative tumors. By characterizing these distribution patterns, the authors aimed to improve the localization and surgical targeting of MRI-negative pathology.</p><p><strong>Methods: </strong>The authors retrospectively reviewed patients with Cushing disease who underwent microscopic transsphenoidal resection by the late Dr. Edward H. Oldfield at the authors' institution from December 2007 to March 2017. Patients were stratified into MRI-positive and MRI-negative cohorts. A standardized pituitary sketch visualizing both coronal and sagittal planes was used for postoperative documentation. For every patient, Dr. Oldfield annotated the anatomical location of the histologically confirmed corticotroph adenoma. Image acquisition, processing, and heat map-based spatial analysis were performed to assess cumulative tumor density. Spatial differences were evaluated with cluster-based correction for multiple comparisons. Surgical outcomes were then compared between the 2 cohorts.</p><p><strong>Results: </strong>A total of 153 patients with Cushing disease and histologically confirmed pituitary corticotroph adenoma (133 MRI-positive and 20 MRI-negative adenomas) were analyzed. Baseline demographic and biochemical characteristics were similar across MRI status. Both cohorts demonstrated similar anatomical presentation, with over 50% of patients presenting with corticotroph adenomas in the anterior aspect of the pituitary gland. MRI-positive tumors were more likely to localize to the lateral and dorsal aspects of the anterior pituitary (p < 0.05). In contrast, MRI-negative adenomas showed no distinct area of increased prevalence. Postoperatively, the MRI-negative cohort had higher nadir cortisol levels (2.9 vs 1.5 μg/dl, p = 0.001) and increased reoperation rates (20% vs 3.8%, p = 0.027). Remission rates were lower in MRI-negative patients but not statistically significant (75.0% vs 91.0%, p = 0.050).</p><p><strong>Conclusions: </strong>MRI-negative corticotroph adenomas were less frequently localized in the lateral and dorsal aspects of the anterior pituitary compared to MRI-positive tumors, with no distinct region of increased prevalence. These findings support a unique surgical strategy that leverages the anatomical distribution of histologically confirmed adenomas to guide gland exploration and resection of hidden tumors. While these observations may provide anatomical context for surgical exploration in radiographically occult disease, operative decision-making should remain guided by intraoperative findings and individual patient anatom","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206936","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":"Quantitative MRI to assess baseline shunt flow in patients with hydrocephalus: a noninvasive tool to aid clinical decision-making.","authors":"Joseph H Ha, Madison E Gutierrez, Jason M Toliao, Isabel Torres, Matthew T Borzage, Eamon K Doyle, Meghan Drastal, Isabella Friedli, Benita Tamrazi, Marvin D Nelson, Pradip P Chaudhari, John C Wood, Clio González-Zacarías, Shana Adise, Jason K Chu, Mark D Krieger, Jason S Hauptman, J Gordon McComb, Stefan Blüml, Peter A Chiarelli","doi":"10.3171/2026.5.JNS253071","DOIUrl":"https://doi.org/10.3171/2026.5.JNS253071","url":null,"abstract":"<p><strong>Objective: </strong>Hydrocephalus is a common yet serious condition, and ventricular shunts are used for lifesaving CSF diversion. Existing methods for shunt evaluation provide correlative/qualitative information, leading to commonplace clinical diagnostic challenges. The aim of this study was to determine accurate and noninvasive measures of volumetric CSF flow rates through ventricular shunts using the phase-contrast (PC) sequence in routine MRI for pediatric patients with hydrocephalus.</p><p><strong>Methods: </strong>The authors conducted a prospective observational cohort study of patients with ventricular shunts who underwent a clinically indicated brain MRI and the adjunct PC-MRI shunt flow sequence at a single center between January 2023 and January 2024. At the study institution, PC-MRI has been integrated as a supplementary imaging technique to quantify shunt flow alongside fast protocol MRI for shunted patients. Clinical and imaging data were collected. Data distributions and paired changes in flow measurements over time were assessed using appropriate statistical tests.</p><p><strong>Results: </strong>Overall, 207 patients (107 male, mean age 11.3 years [range 8 days-27 years]) who underwent PC-MRI were included; 98% had a VP shunt. The mean CSF flow rate was 9.9 ± 8 mL/hour (range 0.5-54 mL/hour). No significant differences were noted by age, sex, etiology of hydrocephalus, valve type, time interval since shunt placement, BMI, fronto-occipital horn ratio, and frontal horn or atrial width. Repeat PC-MRI was performed in 11 patients, and there was no significant difference in flow measurements between initial and follow-up images (p = 0.83) among these patients. PC-MRI identified alterations that accurately demonstrated failure in 3 patients and avoided unnecessary surgery in a fourth patient.</p><p><strong>Conclusions: </strong>Addition of PC-MRI to routine imaging examinations in patients with ventricular shunts accurately and noninvasively measured CSF shunt flow. Flow rate data can provide supplementary information regarding shunt function and serve as a baseline for future comparison assessments. These findings suggest a role for routine acquisition of patient-specific baseline shunt flow measurement in shunted pediatric patients with hydrocephalus.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206949","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 balancing act: ethical challenges in vestibular schwannomas.","authors":"Patrick D Kelly, Fatima Gauhar, Alexander Langerman, Robert J Dambrino Iv, Sean C All, John P Marinelli, Matthew L Carlson","doi":"10.3171/2026.6.JNS252785","DOIUrl":"https://doi.org/10.3171/2026.6.JNS252785","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":3.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206968","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 new era of neurosurgery department chairs in the United States: a national analysis of leadership trends.","authors":"Adham M Khalafallah, Khushi H Shah, Lauren K Tierney, Muneeb K Mohiuddin, Ricardo J Komotar, Allan D Levi","doi":"10.3171/2026.5.JNS26254","DOIUrl":"https://doi.org/10.3171/2026.5.JNS26254","url":null,"abstract":"<p><strong>Objective: </strong>Neurosurgery department chairs play a critical role in shaping clinical practice, research priorities, and workforce development within academic medicine. Prior studies have largely provided cross-sectional snapshots of chair characteristics, limiting understanding of how chair profiles have evolved over time. This study aimed to characterize temporal trends among neurosurgery department chairs in the US.</p><p><strong>Methods: </strong>All neurosurgeons who served as department chair at ACGME (Accreditation Council for Graduate Medical Education)-accredited US neurosurgery residency programs between 2000 and 2025 were identified. Demographic characteristics, educational history, scholarly productivity, and institutional familiarity prior to chair appointment were collected from publicly available sources, Scopus, National Institutes of Health (NIH) RePORTER (Research Portfolio Online Reporting Tools Expenditures and Results), and Google Patents. Chairs were stratified into quartiles based on appointment year, and temporal trends were assessed using chi-square and Kruskal-Wallis tests. Univariable and multivariable logistic regression identified predictors of long-standing chair tenure (> 75th percentile).</p><p><strong>Results: </strong>Between 2000 and 2025, 322 chair tenures were identified (median age at appointment, 48 [IQR 45-54] years), including 112 current chairs (median age 49 [IQR 45-54] years). The median age at appointment increased from 46 to 51 years from the earliest to the most recent quartile (p < 0.001), while female representation rose from 0% to 10.4% (p = 0.001). Additional graduate degrees and fellowship training became more common over time (p < 0.001). Scholarly productivity increased markedly, with median publications rising from 34 to 155, citations from 221 to 3139, and h-indices from 18 to 37 (all p < 0.001). In contrast, the median completed chair tenure declined from 19 to 3 years across cohorts (p < 0.001). On multivariable analysis, earlier appointment year and prior NIH funding were independently associated with longer tenure, whereas age at appointment, fellowship training, and h-index were not.</p><p><strong>Conclusions: </strong>Contemporary neurosurgery department chairs are appointed later in their careers, with substantially greater academic productivity and shorter tenures than prior generations, reflecting a fundamental shift in leadership expectations within academic neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206934","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":"Combining responsive neurostimulation with resection or ablation for treatment of epilepsy: a multicenter experience.","authors":"Christian G Lopez Ramos, Ahmed M Raslan, Vikram R Rao, Edward F Chang, Max Liu, Vaishnav Krishnan, Sameer A Sheth, Danika L Paulo, Sanjay E Patra, David E Burdette, Philip M McCarthy, Christopher Skidmore, Chengyuan Wu, Robert Ziechmann, Lilit Mnatsakanyan, Sumeet Vadera, Dawn Eliashiv, Itzhak Fried, Muayad Alzuabi, Imran H Quraishi, Jason Gerrard, Tuan Bui, Utku Uysal, Michael Kinsman, Martin McCandless, Lia D Ernst","doi":"10.3171/2026.5.JNS252911","DOIUrl":"https://doi.org/10.3171/2026.5.JNS252911","url":null,"abstract":"<p><strong>Objective: </strong>Despite advances in surgical and neuromodulatory treatments, a substantial proportion of patients with drug-resistant epilepsy remain ineligible for standalone resection or ablation. Combining resection or laser interstitial thermal therapy (LITT) with responsive neurostimulation (RNS) has emerged as a promising approach for patients with multifocal seizure onset or eloquent cortex involvement. However, the clinical impact of combination surgery remains poorly characterized. The aim of this study was to characterize the clinical rationale and surgical decision-making used across multiple high-volume epilepsy centers performing combination surgeries, and to evaluate the seizure outcomes and safety profile associated with this approach.</p><p><strong>Methods: </strong>This retrospective study included patients with drug-resistant epilepsy who underwent RNS implantation in combination with resection or LITT at 9 epilepsy centers and had ≥ 1 year of follow-up. Demographic, clinical, surgical, and seizure outcome data were collected. The primary outcome was seizure reduction at 1 year. Secondary outcomes included the Clinical Global Impression and adverse events.</p><p><strong>Results: </strong>Overall, 73 patients (40 male, mean age 34 years) with a mean epilepsy duration of 21 years were included in this analysis. The most common etiology was unknown (37%), followed by cortical malformation (16%). Most patients experienced focal impaired consciousness (FIC, 78%) and focal to bilateral tonic-clonic (FBTC, 70%) seizures. Prior resection was performed in 23%. Combination procedures were performed on the same day in 89% of patients. RNS implantation was concurrent with resection in 92% and with LITT in 8.2% of patients. Neocortical and mesial temporal regions accounted for 61% of resection/ablation targets. More than two-thirds of RNS leads were subdural strips, most commonly in the left hemisphere (73%). Indications for the combined approach included eloquent cortex involvement (67%) and multifocal seizure onset (33%) or both (9.6%). At 1 year, mean seizure reductions were 53% for focal impaired, 69% for FIC, and 67% for FBTC seizures. Overall, 48% of patients had at least a 6-month period of seizure freedom, and 4 patients had no seizures after surgery. Significant global clinical improvement (much or very much improved) was observed in 79% of patients. Three patients experienced infection, and 1 patient died due to causes unrelated to surgical treatment (sudden unexpected death in epilepsy).</p><p><strong>Conclusions: </strong>Combined RNS with resection or ablation might provide meaningful seizure control in complex drug-resistant epilepsy with acceptable safety profiles. These findings describe current practice and support further investigation of hybrid surgical strategies in patients with challenging seizure networks as a potential treatment strategy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207019","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":"Brain network changes in patients with glioma-related epilepsy after frontal resection.","authors":"Shengyu Fang, Jiangwei Wang, Zhiyin Zhang, Yuzhe Li, Zhiyan Sun, Chunyao Zhou, Yinyan Wang, Xing Fan, Tao Jiang","doi":"10.3171/2026.4.JNS26314","DOIUrl":"https://doi.org/10.3171/2026.4.JNS26314","url":null,"abstract":"<p><strong>Objective: </strong>Clinical factors such as IDH status, preoperative seizures, and frontal tumor location influence the prognosis of postoperative glioma-related epilepsy (GRE), but the underlying network-level mechanisms remain unclear. This study aimed to identify network-based predictors of postoperative GRE.</p><p><strong>Methods: </strong>The authors retrospectively analyzed 109 patients with frontal glioma (76 left sided). All patients underwent preoperative and 1-week postoperative resting-state functional MRI and diffusion tensor imaging. Changes in network characteristics, including structural-functional coupling and functional connectivity (FC), were evaluated. Using the left-sided cohort as the training set, Cox proportional hazards regression analysis was applied to identify network-based risk factors for postoperative GRE and construct a predictive model. The right-sided cohort served as a validation set.</p><p><strong>Results: </strong>Patients with postoperative GRE showed reduced structural-functional coupling between the dorsal attention network (DAN) and the frontoparietal network (FPN), along with decreased FC within and between these networks. Increased DAN-FPN coupling and higher FC between the lesional-hemisphere prefrontal thalamus and the whole brain were protective against postoperative GRE. The area under the receiver operating characteristic curve was 0.785 in the training cohort and 0.922 in the validation cohort (both p < 0.0001).</p><p><strong>Conclusions: </strong>Altered structural-functional coupling and FC between attention-related networks are associated with postoperative GRE in frontal glioma. Enhanced DAN-FPN coupling and thalamocortical connectivity may serve as protective network markers.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147659","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":"Social determinants of health and increased length of stay following endoscopic endonasal pituitary surgery.","authors":"Anoop S Chinthala, Chad A Purcell, Bobby T Woodburn, Ajay Patel, Matthew Pease, Angela Richardson, Satyan B Sreenath, Mitesh V Shah, Joao Paulo Almeida","doi":"10.3171/2026.4.JNS252634","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252634","url":null,"abstract":"<p><strong>Objective: </strong>Socioeconomic disparities are increasingly recognized as contributors to variable healthcare outcomes, including hospital length of stay (LOS). This study investigates how social factors, including the Social Vulnerability Index (SVI) and Area Deprivation Index (ADI), influence postoperative LOS in patients undergoing endoscopic endonasal pituitary surgery.</p><p><strong>Methods: </strong>The authors retrospectively analyzed patients undergoing endoscopic transsphenoidal resection of pituitary adenoma or cyst at a single academic institution between January 2021 and December 2024. SVI scores and ADI percentiles were assigned based on ZIP codes. LOS comparisons across social variables were performed using Wilcoxon rank-sum, Pearson's chi-square, and Fisher's exact tests. Linear regression was used to assess the relationship between LOS, SVI, and ADI. Univariate and multivariable logistic regression were used to identify predictors of prolonged LOS (PLOS; > 3 days).</p><p><strong>Results: </strong>Overall, 158 patients (53% male, mean age 53 years) were included in this analysis, with a mean LOS of 4.58 days (SD 3.33 days). In the univariate analysis, female sex (p = 0.008), unemployment (p = 0.040), unmarried status (p = 0.016), lack of a primary care provider (p = 0.012), and an ADI > 50th percentile (p = 0.014) were associated with PLOS. Postoperative diabetes insipidus showed a strong association with PLOS (p < 0.001). Linear regression demonstrated that higher ADI percentiles (r = 0.211, p = 0.012) and larger tumors (r = 0.234, p = 0.005) predicted longer LOS. In the multivariable model, postoperative diabetes insipidus (OR 62.80, 95% CI 12.09-510.67, p < 0.001), unemployment (OR 9.00, 95% CI 2.06-50.54, p = 0.006), and unmarried status (OR 9.45, 95% CI 2.45-47.26, p = 0.003) independently predicted PLOS.</p><p><strong>Conclusions: </strong>Social determinants of health, particularly a higher ADI percentile and unemployment, were associated with prolonged hospitalization following endoscopic pituitary surgery. These findings highlight the impact of social determinants on the postoperative course and surgical recovery. Increased understanding of these associations might enable interventions to reduce LOS and related healthcare costs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148495","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":"Morphological subtypes of Chiari malformation type I and clinical outcomes after posterior fossa decompression.","authors":"Pranav Nanda, Zachary A Kons, William J Muñoz, Pratik Talati, Arjun R Khanna, Elizabeth G Shannon, Kristopher T Kahle, William E Butler","doi":"10.3171/2026.3.JNS241132","DOIUrl":"https://doi.org/10.3171/2026.3.JNS241132","url":null,"abstract":"<p><strong>Objective: </strong>Chiari malformation type I (CM-I) is the most common structural hindbrain defect in humans and causes debilitating headaches and other neurological symptoms frequently requiring surgery. Although patients' brains have heterogeneous shapes, diagnosis is based on a single radiographic measure with only 1 available pathology-directed treatment. The authors sought to determine whether there are distinct morphological subtypes of CM-I and to determine whether patients with different subtypes differ in clinical response to neurosurgical decompression.</p><p><strong>Methods: </strong>For this cohort study, 186 adult patients with CM-I (152 females, 34 males; mean age 40.6 years) with high-resolution T1-weighted MR images were retrospectively identified from the records of 2 large-volume tertiary care centers. Cerebellar morphology was measured by nonlinearly transforming T1-weighted MRI data to a template brain to generate cerebellar deformation maps, and spectral clustering was performed to identify morphological patient subtypes. Headache freedom after posterior fossa decompression (PFD) was compared between morphological clusters using Kaplan-Meier analysis.</p><p><strong>Results: </strong>Three distinct morphological subtypes of CM-I were identified: cluster A was characterized by posteroinferior cerebellar fullness and platybasia; cluster B, by midline anteroposterior compression; and cluster C, primarily by tonsillar descent. Similar clusters were generated after random partitioning of patients, and cluster assignments using partitioned data and the full data set were significantly associated (p < 0.0001). After PFD, headaches were found to recur more frequently and sooner in patients with cluster B morphology (HR 6.0, 95% CI 1.5-22.9; p = 0.01).</p><p><strong>Conclusions: </strong>These analyses suggest that there are different subtypes of CM-I in patients, with distinct cerebellar shapes that respond differently to PFD, indicating that global cerebellar morphology may inform more personalized evaluation and treatment of CM-I. Future research should involve independent validation of this cluster scheme, identification of genetic and other etiological factors responsible for phenotypic heterogeneity, and optimization of treatment for patients with cluster B morphology, which was observed here to be associated with less effective surgical outcomes. Broadly, implementation of automated statistical shape analysis may represent an effective method to identify clinically meaningful subgroups of diseases characterized by structural deformations.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147989","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":"Douglas W. C. Northfield (1902-1976): his crucial contribution to safer craniopharyngioma surgery.","authors":"Ruth Prieto, Laura Barrios, José María Pascual","doi":"10.3171/2026.5.JNS26584","DOIUrl":"https://doi.org/10.3171/2026.5.JNS26584","url":null,"abstract":"<p><p>Douglas W. C. Northfield (1902-1976) was one of the pioneers of modern British neurosurgery. He trained under Sir Hugh Cairns (1896-1952) at The London Hospital, replacing him as director of the neurosurgical unit. Cairns was instrumental in transmitting Cushing's work methodology, including the painstaking upkeep of detailed clinical records with insightful reflections. Northfield's dismal surgical outcome record with craniopharyngiomas (CPs) tormented him. An examination of his records held by the Barts Health NHS Trust Archives allowed the authors to identify 52 CP patients, 38 of whom underwent surgery with a mortality rate as high as 26.3%. Like Cushing, Northfield gained insight through the CP brain specimens of his patients who had died. This served to illuminate the definitive correlation between poor surgical outcome and anatomical involvement of the tuber cinereum by the tumor. Northfield proposed a novel CP topographical classification based on the type of tumor relationship with the basal hypothalamus. Despite this scheme allowing for both predicting patient outcome and tailoring surgical strategy, it fell into oblivion. On the 100th anniversary of the Society of British Neurological Surgeons, this article highlights Northfield's legacy as a leading advocate for safer, hypothalamus-sparing CP surgery, a concept now widely accepted by internationally recognized experts.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147227","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":"Magnetically guided microrobot via minimally invasive percutaneous cisternal access: a first preclinical evaluation.","authors":"Oana M Mereuta, Julien Ognard, William G Loudon, Esref Alperen Bayraktar, Yasuhito Ueki, Daying Dai, Jack Weissberg, Suehyun Cho, Evaline Wang, Teresa Yuan, Anish Vaghela, Xiaobo Ma, Sarah Lortscher, Dan R Montonye, Christopher K Gow, Edward S Ahn, Waleed Brinjikji, Ramanathan Kadirvel","doi":"10.3171/2026.4.JNS252541","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252541","url":null,"abstract":"<p><strong>Objective: </strong>Magnetically guided microrobots could enable minimally invasive intracranial interventions by navigating CSF spaces without traversing brain parenchyma. However, clinical translation requires in vivo validation of delivery, control, retrieval, and short-term safety under realistic workflow conditions. The aim of this study was to assess the feasibility and initial safety of percutaneous cisterna magna access, microrobot navigation, and retrieval using an image-integrated electromagnetic coil platform in a large-animal model, targeting future application to Dandy-Walker malformation cyst fenestration.</p><p><strong>Methods: </strong>In this Good Laboratory Practice-compliant ovine study, 7 male sheep were allocated to an MRI-only control group (n = 1), flexion control group (n = 1), and treatment group (n = 3; percutaneous cisternal access, deployment of a 3.5 × 7-mm Parylene-C-coated bladed microrobot with a neodymium core, magnetic navigation, scripted dwell, and retrieval), with 2 animals designated as alternates. Preoperative MRI was used for planning, with intraoperative cone-beam CT fusion and biplanar fluoroscopy. The follow-up period was 28 days and included daily observation, weekly neurological examination, and analysis of hematology/chemistry, intraoperative CSF, and terminal necropsy with histopathology. Outcomes were descriptive.</p><p><strong>Results: </strong>The full workflow was completed in all 3 treated animals without conversion or rescue. Cannulation succeeded on the first attempt; continuous fluoroscopic visibility and stable magnetic control were maintained; and retrieval succeeded in a single maneuver. Postoperative recovery was uneventful, with weight gain and no neurological deficits over 28 days of follow-up. Laboratory values were within reference ranges except for 1 case of transient leukocytosis (day 0) that resolved. CSF was acellular/normal. Necropsy showed localized procedure-site changes only (dural fibrosis, thin adhesions in 2 of 3 treated animals). Histology revealed focal superficial vermian gliosis ≤ 2 mm in 2 of 3 treated animals without hemorrhage, necrosis, or off-target injury, and controls were within normal limits (1 case of minimal incidental axonal change in the flexion control).</p><p><strong>Conclusions: </strong>Percutaneous cisternal delivery and retrieval of an untethered microrobot were feasible and tolerated in sheep, with localized tissue responses at 28 days. These findings support further studies focused on longer follow-up, workflow optimization, and disease-specific efficacy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149203","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}