Journal of neurosurgery最新文献

{"title":"Long-term pain control and reduced opioid use through novel selection criteria for peripheral nerve and motor cortex stimulation.","authors":"Kelsey DeLisio, Jonathan Miller, Jennifer Sweet","doi":"10.3171/2025.2.JNS232686","DOIUrl":"https://doi.org/10.3171/2025.2.JNS232686","url":null,"abstract":"<p><strong>Objective: </strong>Peripheral nerve stimulation (PNS) and motor cortex stimulation (MCS) for medically refractory neuropathic facial pain offer an alternative to traditional surgical approaches and therapeutic techniques. Many existing studies lack large sample sizes, long-term follow-up, or clear patient selection guidelines, making well-defined outcomes variable. The objective of this cohort study was to present a large series of patients with PNS or MCS and long-term outcomes and propose an algorithm for determining which surgical technique to use according to patient histories and physical examinations.</p><p><strong>Methods: </strong>Thirty-three consecutive cases of trial and permanent placement of PNS and MCS electrodes by two surgeons at a single site from January 2013 through March 2023 were retrospectively reviewed from a prospectively collected database to assess pain coverage and surgical outcomes. The average length of follow-up for this cohort was 30.12 (range 2-104) months.</p><p><strong>Results: </strong>Of those who reported at least good reduction of pain at trial (≥ 50% reduction), 80.0% of PNS and 72.7% of MCS patients experienced good (50%-74% pain relief) or excellent (75%-100% pain relief) coverage for 6 months or longer. Sixty-two percent of presurgical opioid users switched to nonopioid medications or no medication following surgery. Fifty-seven percent of patients proceeded with end-of-life implantable pulse generator revision given their continued pain relief.</p><p><strong>Conclusions: </strong>Careful consideration of patient eligibility for PNS and MCS based on pain distribution and quality results in better overall outcomes, decreased opioid use, and long-term device usage in patients with neuropathic head and facial pain seeking surgical intervention.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715118","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":"Ki-67 in meningioma: distribution and implications.","authors":"Xiaopeng Guo, Ruchit V Patel, James A Lederer, David M Meredith, Wenya Linda Bi","doi":"10.3171/2025.4.JNS25438","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25438","url":null,"abstract":"<p><strong>Objective: </strong>Ki-67 is a widely used marker of proliferation in meningiomas, influencing prognostic assessment and treatment decisions, including adjuvant radiation therapy. However, it is increasingly appreciated that some meningiomas are enriched with immune infiltration, which may confound Ki-67 interpretation as both immune and tumor cells exhibit proliferative potential. The authors aimed to dissect the cellular source and distribution of Ki-67 within the meningioma microenvironment and explore their clinical, genomic, and biological associations.</p><p><strong>Methods: </strong>The cellular composition of 32 resected meningiomas, including tumor and immune lineages, was profiled with single-cell mass cytometry (cytometry by time of flight [CyTOF]) and single-cell RNA sequencing (scRNAseq). The Ki-67 index and mitotic count were assessed by immunohistochemistry. CDKN2A/B deletion and high-risk chromosome alterations were evaluated to establish a molecular Integrated Grade. An extrapolation cohort of 448 newly diagnosed meningiomas with gross-total resection was used for validation.</p><p><strong>Results: </strong>Ki-67 is expressed by multiple cell lineages, both tumor and immune, as inferred by CyTOF on 77,498 cells and scRNAseq on 45,460 cells. The composition of cells contributing to Ki-67 expression changes from WHO grade 1 to grades 2 and 3, with Ki-67+ cells in WHO grade 1 tumors composed of mostly myeloid-lineage cells, while nonimmune tumor cells dominated Ki-67+ cells in grade 2 and 3 meningiomas. Ki-67 indices were markedly elevated in meningiomas from older patients (age > 70 years) and influenced by the timing of radiation exposure. The optimal Ki-67 threshold associated with future recurrence varied with time of follow-up. Furthermore, the authors highlight two scenarios of focally elevated Ki-67 expression, central infarction and extramedullary hematopoiesis, in which apparent proliferation does not correlate with tumor aggressiveness.</p><p><strong>Conclusions: </strong>These findings unveil the complexity of Ki-67 expression in meningiomas, emphasizing the need for a nuanced interpretation of proliferation indices. The Ki-67 index remains a reliable parameter for assessing the clinical, molecular, and prognostic characteristics of meningiomas on careful evaluation and consideration of potential confounding factors.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715117","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":"Identification and relevance of ultra-early progression after resection of glioblastoma.","authors":"Levin Häni, Arsany Hakim, Lorenz Gehrig, Michal Staruch, Johannes Goldberg, Severin Rüssli, Nicole Söll, Andreas Raabe, Ekin Ermiş, Philippe Schucht","doi":"10.3171/2025.3.JNS242212","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242212","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to analyze the relevance of tumor progression in the interval between surgery and radiation therapy (RT) in patients with glioblastoma and its interaction with the extent of resection.</p><p><strong>Methods: </strong>In a retrospective cohort study, all patients who underwent resection for glioblastoma, IDH wildtype, at a single institution from January 2011 to February 2023 with early postoperative and additional pre-RT MRI available for analysis were included. Early postoperative MR images were graded according to whether they showed no enhancing or nonenhancing residual tumor (group 1a), no contrast-enhancing but residual nonenhancing tumor (group 1b), or residual contrast-enhancing tumor (group 2). The primary outcome was overall survival. Risk factors for ultra-early progression were assessed using a binary logistic regression analysis.</p><p><strong>Results: </strong>A total of 133 patients (median age 66.0 years) were included, and 64 patients (48.1%) had ultra-early progression. Overall survival was significantly worse among patients with ultra-early progression (p < 0.001). The only risk factor identified for ultra-early progression was the resection category (p < 0.001). While ultra-early progression was seen in 10.3% of patients in group 1a, it occurred in 43.8% and 85.2% of patients in groups 1b and 2, respectively (p < 0.001). Patients with ultra-early progression showed no difference in survival whether or not they had undergone complete resection of enhancing tumor (p = 0.850).</p><p><strong>Conclusions: </strong>Ultra-early progression after resection of a glioblastoma is a frequent finding with a profound prognostic impact. Complete resection of enhancing and nonenhancing tumors reduced the frequency of ultra-early progression. Nevertheless, new strategies for management of ultra-early progression are urgently needed to improve prognosis.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715116","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":"Operative neurosurgery for traumatic subdural hematoma: association between trauma center variation and patient outcomes.","authors":"Vikas N Vattipally, Kathleen R Ran, Debraj Mukherjee, Jose I Suarez, Judy Huang, Chetan Bettegowda, Elliott R Haut, Joseph V Sakran, Christopher Witiw, David Gomez, Tej D Azad, James P Byrne","doi":"10.3171/2025.3.JNS242811","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242811","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic subdural hematoma (SDH) is a common form of traumatic brain injury (TBI) that often represents a neurosurgical emergency. Surgical evacuation is recommended for SDH with midline shift (MLS) > 5 mm, regardless of the presenting Glasgow Coma Scale (GCS) score; however, real-world practice is unknown. The objective of this study was to test the hypothesis that significant variation exists in the tendency for operative neurosurgical intervention for traumatic SDH among trauma centers (TCs) and that this variation is associated with patient outcomes.</p><p><strong>Methods: </strong>The authors performed a retrospective cohort study of adult patients (age ≥ 18 years) treated for blunt severe TBI (GCS score ≤ 8) and SDH with MLS > 5 mm at level I and II TCs participating in the American College of Surgeons Trauma Quality Improvement Program (2017-2019). Patients with nonsurvivable injuries (Abbreviated Injury Scale score 6), advance directives, or emergency department death were excluded. Hierarchical logistic regression was used to estimate each TC's unique odds of performing operative neurosurgery for traumatic SDH. Risk adjustment accounted for patient baseline and injury characteristics. TCs were grouped into quartiles of increasing tendency for neurosurgery. The risk-adjusted association between TC tendency for operative neurosurgery and outcomes was then measured. The primary outcome was inpatient mortality. The secondary outcome was favorable discharge, defined as discharge to home or rehabilitation.</p><p><strong>Results: </strong>The authors identified 13,087 patients with traumatic SDH treated at 454 level I and II TCs. Significant variation in TC tendency for operative neurosurgery was observed. Specifically, TCs with the greatest tendency for neurosurgical intervention (quartile 4) performed surgery on 60% of patients, whereas TCs with the lowest tendency (quartile 1) performed surgery on only 26%, even though there were no differences in GCS scores or pupillary examination findings. After risk adjustment, a greater hospital tendency for neurosurgical intervention was associated with lower inpatient mortality and higher odds of favorable discharge. Patients with traumatic SDH treated at TCs with the highest versus the lowest tendency for neurosurgery were 30% less likely to die (adjusted odds ratio [aOR] 0.7, 95% CI 0.6-0.8) and more likely to have a favorable discharge (aOR 1.3, 95% CI 1.1-1.6). These effects were most pronounced among patients with abnormal pupillary examination findings.</p><p><strong>Conclusions: </strong>Significant variation exists between trauma centers in performing operative neurosurgery for traumatic SDH. The TCs more likely to perform surgery were associated with lower odds of inpatient mortality and higher odds of a favorable discharge. Consensus-based guidelines are needed to improve standardization in the care of patients with traumatic SDH.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715120","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":"Comparison of clinical and radiological outcomes using solely particles versus particles with coils in middle meningeal artery embolization for chronic subdural hematoma: a longitudinal comparative cohort study.","authors":"Jeffrey Turnbull, Joshua Caskey, Ammar Alsalahi, Daniel W Griepp, Shivum Desai, Boyd Richards, Prashant Kelkar, Chad F Claus, Julius Griauzde","doi":"10.3171/2025.3.JNS242385","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242385","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (cSDH) recurrence is a significant cause of morbidity in neurosurgical patients. Middle meningeal artery embolization (MMAe) effectively reduces cSDH recurrence by targeting its associated inflammatory cascade. Delayed recanalization can occur from proximal branches of the middle meningeal artery (MMA) after use of particle embolic agents. Surgeons may utilize coil embolization in addition to particle embolic agents to achieve proximal vessel control. This study compares reaccumulation rates for cSDH patients undergoing particle embolization of the MMA with and without coil embolization.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data was performed on the records of patients who underwent particle MMAe with or without coils for cSDH at the authors' institution from 2021 to 2023 The primary outcome was cSDH recurrence at CT follow-up at least 1 month after MMAe.</p><p><strong>Results: </strong>Sixty-two patients underwent 81 embolization procedures with particles alone (n = 32) or particles and coils (n = 49). There was no significant difference in recurrence between particles versus particles and coils (6.3% vs 10.2%, p = 0.698). There was a statistical difference in procedure length (54.8 ± 28.7 vs 85.9 ± 26.5 minutes, p < 0.001) and fluoroscopy time (34.9 ± 20.8 vs 48.8 ± 24.7 minutes, p = 0.01) between patients who underwent particle embolization versus those who underwent embolization with particles and coils. A noninferiority analysis demonstrated no significant difference between groups in treatment failure, hematoma expansion, and follow-up size > 1 cm.</p><p><strong>Conclusions: </strong>In the setting of cSDH, MMAe using particles only versus particles with coils shows similar rates of hematoma reaccumulation and resolution. Procedural time and fluoroscopy time were significantly reduced within the particle embolization-alone cohort. When comparing hematoma resolution and expansion, follow-up hematoma size > 1 cm, and decrease in hematoma size > 1 cm between groups, embolization using particles alone was not inferior to embolization using particles supplemented with coils.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715115","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":"Metabolic syndrome as a modifiable risk factor for complications after epilepsy surgery.","authors":"Nikita Das, Akshay Sharma, Jingdi Shen, Maxime Munyeshyaka, Deborah Vegh, William Bingaman, Daniel M Rotroff, Lara Jehi","doi":"10.3171/2025.4.JNS242862","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242862","url":null,"abstract":"<p><strong>Objective: </strong>Metabolic syndrome (MetS) is a growing public health concern in what has been called a \"global epidemic.\" The aim of this study was to investigate how MetS influences postoperative seizure freedom outcomes and complications following elective neurosurgical intervention for drug-resistant epilepsy (DRE), offering an opportunity to uncover modifiable outcome drivers.</p><p><strong>Methods: </strong>Adult patients with DRE who underwent a first resective epilepsy surgery from 2000 to 2017 were identified retrospectively from a prospectively collected institutional outcomes registry. MetS was defined as having ≥ 3 of 4 diagnostic criteria: obesity, hyperglycemia, hypertension, or dyslipidemia. Patients who met 2 criteria preoperatively (pre-MetS cohort) and patients who met ≥ 3 criteria preoperatively (MetS cohort) were matched with non-MetS patients by using covariates classically linked with surgical outcomes, including age at surgery, sex, epilepsy duration, seizure frequency, prior generalized tonic-clonic seizures, abnormal MRI findings, handedness, surgical type, and Charlson Comorbidity Index. Differences in postoperative complications and ICU admissions within 30 days and hospital length of stay (LOS) were analyzed using risk ratios and the average treatment effect (ATE). Differences in postoperative seizure freedom outcomes were quantified using Kaplan-Meier analyses.</p><p><strong>Results: </strong>Propensity score matching (PSM) achieved a symmetric covariate balance between the pre-MetS and MetS cohorts and their non-MetS counterparts (standardized mean difference after PSM < 0.1 and ≤ 0.25, respectively). Of 1466 patients who underwent surgery for DRE, 441 (30.1%) met ≥ 2 diagnostic criteria (pre-MetS cohort, n = 339; MetS cohort, n = 102). The pre-MetS cohort had higher postoperative complication rates (RR 1.25, 95% CI 1.04-1.52) and longer LOS (ATE 1.02 [SE 0.34], p = 0.01) compared with the matched non-MetS cohort, but did not differ significantly with respect to postoperative ICU admissions (RR 1.59, 95% CI 0.66-3.83). Patients with MetS had a higher risk of postoperative complications (RR 1.99, 95% CI 1.39-2.86) than non-MetS patients, although differences in ICU admission (RR 1.32, 95% CI 0.47-3.74) and LOS (ATE 0.72 [SE 0.43], p = 0.20) between groups were insignificant. There were no significant differences in postoperative seizure freedom outcomes between the pre-MetS or MetS cohorts and their non-MetS counterparts (p = 0.52 and p = 0.71, respectively).</p><p><strong>Conclusions: </strong>Preoperative MetS could increase the risk of major postoperative morbidity after resective epilepsy surgery. Early identification and management of MetS components could be important for optimizing surgical outcomes for patients with DRE.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715119","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":"Race- and ethnicity-associated differences in characteristics and outcomes of treated unruptured intracranial aneurysms: an analysis of the NeuroVascular Quality Initiative-Quality Outcomes Database cerebral aneurysm registry.","authors":"Varun Padmanaban, Taylor E Smith, Nanthiya Sujijantarat, Manvita Mareboina, Junjia Zhu, Shouhao Zhou, Sameer A Ansari, Daniel H Sahlein, Juan G Tejada, D Andrew Wilkinson, Scott D Simon, Ephraim W Church, Kevin M Cockroft","doi":"10.3171/2025.4.JNS25200","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25200","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to utilize a large, national, prospectively collected procedural registry to investigate racial and ethnic differences in aneurysm morphology, aneurysm treatment modality, and surgical outcomes among patients undergoing treatment for unruptured intracranial aneurysms (UIAs) in the US.</p><p><strong>Methods: </strong>The NeuroVascular Quality Initiative-Quality Outcomes Database was queried for patients who underwent treatment of a UIA. Comparisons of demographics, aneurysm characteristics, treatments, and outcomes were made across races and ethnicities. Due to small sample sizes in several racial and ethnic groups, non-Hispanic Whites (NHWs) were compared with all other races combined, defined as Black, Hispanic, and other non-Whites (BHONWs). Multivariate logistic regression was performed to control for known confounders.</p><p><strong>Results: </strong>Three thousand forty-two patients receiving treatment for UIAs were analyzed, consisting of 74.4% NHW, 12.1% Black, 7.6% Hispanic, 3.2% Asian, 1.7% American Indian, and 0.4% Pacific Islander patients. NHW patients were less frequently symptomatic (23.9% vs 33.2%, p < 0.0001), less likely to have open surgery (14.4% vs 20.4%, p < 0.0001), and more likely to have posterior circulation aneurysms treated (17.6% vs 9.2%, p < 0.0001). There was no significant difference in intraoperative complication rates (3.8% vs 4.7%, p = 0.273). NHW patients were less likely to have a postoperative complication (4.3% vs 7%, p = 0.005). Patients had similar rates of aneurysm occlusion. NHW patients were less likely to have a modified Rankin Scale (mRS) score ≥ 3 at discharge (7.8% vs 11.2%, p = 0.02), length of stay (LOS) ≥ 3 days (24.4% vs 35.5%, p < 0.0001), and be discharged to a nursing home or die (1.5% vs 2.8%, p = 0.029). After controlling for known confounders, BHONW patients had a higher rate of postoperative complications (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.07-2.43; p = 0.021), mRS score > 2 at discharge (aOR 1.72, 95% CI 1.13-2.6; p = 0.011), LOS ≥ 3 days (aOR 1.41, 95% CI 1.12-1.77; p = 0.004), and poor discharge status (aOR 2.14, 95% CI 1.10-4.09; p = 0.02).</p><p><strong>Conclusions: </strong>Analysis of the largest, prospectively collected, contemporary procedural registry indicated significant racial/ethnic differences in aneurysm characteristics, treatment modalities, and outcomes in patients undergoing treatment of UIAs in the US. Further studies are needed to reveal possible solutions to mitigate these disparities.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715121","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":"Recurrence of initial angiographic occlusion in intracranial dural arteriovenous fistulas.","authors":"Xin Su, Yongjie Ma, Huishen Pang, Zihao Song, Huiwei Liu, Chao Zhang, Yiguang Chen, Beichuan Zhao, Mingyue Huang, Liyong Sun, Guilin Li, Peng Hu, Tao Hong, Ming Ye, Hongqi Zhang, Peng Zhang","doi":"10.3171/2025.3.JNS25203","DOIUrl":"https://doi.org/10.3171/2025.3.JNS25203","url":null,"abstract":"<p><strong>Objective: </strong>Recurrence after an initial angiography-determined cure of dural arteriovenous fistula (DAVF) has been reported, with risk factors identified in a few studies; however, some findings remain controversial. The objective of this study was to evaluate a large cohort of patients with DAVFs to estimate the recurrence rate and identify factors influencing recurrence.</p><p><strong>Methods: </strong>Patient data for this study were derived from the Dural Arteriovenous Fistula Research and Management in China (DREAM-INI) database, compiled from a single-center retrospective study conducted in China. This analysis included only patients in whom an immediate complete cure was achieved who had subsequent angiographic follow-up. Two patient groups were compared: patients in whom a sustained durable cure was achieved and those who experienced recurrence following the initial cure. In addition to comparing baseline characteristics and follow-up results, potential risk factors for recurrence were examined and a time-to-recurrence analysis was performed.</p><p><strong>Results: </strong>Among the 1101 patients included in the DREAM-INI dataset, 510 met the inclusion criteria for this study. Of these, 41 patients with an initially cured DAVF had 47 recurrence events; 48.8% developed new fistulas at distant sites, 36.6% had in situ recurrence, and 14.6% had both types of recurrence. The overall recurrence rate was 8.0%, with anticipated recurrence rates of 13.9% at 36 months and 24.1% at 105 months. Recurrence was more frequently observed in Borden type II DAVFs. Identified risk factors for recurrence included age < 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion.</p><p><strong>Conclusions: </strong>DAVF recurrence can be classified as in situ recurrence and recurrence at other sites, both of which are closely linked to unresolved venous hypertension and the previously masked portion of the fistula. Risk factors for recurrence included age younger than 45 years, a transverse-sigmoid sinus location, multiple fistulae, pial arterial supply, and venous congestion. All patients with cured DAVFs, particularly those with identified risk factors, were advised to undergo angiographic follow-up beyond 1 year.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715133","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":"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}