Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Concerning interposition versus transposition for MVD in trigeminal neuralgia.","authors":"Melanie Kristt, Guy M McKhann, Raymond F Sekula","doi":"10.3171/2025.6.JNS251497","DOIUrl":"https://doi.org/10.3171/2025.6.JNS251497","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091986","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":"Role of post-thrombectomy glymphatic flow in futile recanalization in large-vessel occlusion ischemic stroke.","authors":"Alan J Finkelstein, Matthew T Sipple, Sajal Medha K Akkipeddi, Racquel Whyte, Gurkirat Singh Kohli, Stephen Susa, Rohin Singh, Prasanth Romiyo, Jianhui Zhong, Tarun Bhalla, Thomas Mattingly, Vincent N Nguyen, Maiken Nedergaard, Matthew T Bender, Derrek Schartz","doi":"10.3171/2025.5.JNS25210","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25210","url":null,"abstract":"<p><strong>Objective: </strong>Stroke is a leading cause of global death and disability, with mechanical thrombectomy remaining the optimal treatment approach for large-vessel occlusion (LVO) ischemic stroke. Despite endovascular recanalization, nearly half of patients experience poor functional outcomes, a phenomenon termed \"futile recanalization.\" The cerebral glymphatic system has emerged as a potential, yet underexplored, therapeutic target. The aim of this study was to use glymphatic diffusion tensor analysis on post-thrombectomy MRI to evaluate the association between glymphatic flow, clinical outcomes, and futile recanalization in patients with LVO ischemic stroke.</p><p><strong>Methods: </strong>In this retrospective study, 133 patients with anterior LVO ischemic stroke and available post-thrombectomy MRI at a single center from 2017 to 2021 were identified. Futile recanalization was defined by a modified Rankin Scale score > 2 at 90 days despite achieving complete or near-complete angiographic recanalization (modified thrombolysis in cerebral infarction grades 2b-3). Diffusion tensor imaging along the perivascular space was used to evaluate glymphatic function in patients with futile recanalization and patients with functional independence at 90 days. Spearman's rank correlation was used to examine associations between the along the perivascular space index and clinical variables. Effect sizes were calculated and reported using Cohen's d.</p><p><strong>Results: </strong>Fifty-five patients (24 male, mean age 73.9 years) with anterior circulation LVO ischemic stroke and adequate post-thrombectomy MRI were included for analysis. Overall, glymphatic clearance was lower on the infarcted side compared with the contralateral side (p = 0.035). Patients with futile recanalization had lower glymphatic flow compared with those with functional independence at 90 days (p = 0.049). Additionally, glymphatic flow was significantly associated with the presenting National Institutes of Health Stroke Scale score (ρ = -0.46, p = 0.002).</p><p><strong>Conclusions: </strong>These findings suggest that patients with futile recanalization have comparatively worse glymphatic clearance. Further research is required to clarify the relationship between futile recanalization and the glymphatic system, which could facilitate the development of therapeutic adjuncts.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092002","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":"Risk factors of wall calcification in unruptured intracranial aneurysms.","authors":"Leonardo F Costa, Maarten J Kamphuis, Oluwadamilola Akanji, Irene C van der Schaaf, Laura T van der Kamp, Mervyn D I Vergouwen, Nima Etminan, Gabriel J E Rinkel","doi":"10.3171/2025.5.JNS25144","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25144","url":null,"abstract":"<p><strong>Objective: </strong>Wall calcification in unruptured intracranial aneurysms (UIAs) increases the risk of complications of microsurgical aneurysm treatment. Therefore, information on wall calcification is important in deciding on the indication and modality of preventive treatment. However, wall calcification is often not visible on MR angiography. The authors studied risk factors for aneurysm wall calcifications to identify patients who should undergo preprocedural CT imaging to detect wall calcifications.</p><p><strong>Methods: </strong>From two international cohorts of patients with single or multiple UIAs, data were collected on age, sex, smoking status, hypertension, aneurysm location, aneurysm size, and morphological parameters associated with increased risk for rupture (i.e., at-risk morphology = aspect ratio > 1.6, size ratio > 3, presence of lobulations, and/or irregular shape). Logistic regression was used to calculate odds ratios (ORs) with corresponding 95% confidence intervals (CIs) to investigate risk factors for wall calcification. Using receiver operating characteristic analysis in one cohort, a size cutoff value was determined for ruling out aneurysm wall calcification, which was validated in the other cohort.</p><p><strong>Results: </strong>Two hundred fifty-five patients with 306 UIAs were included. In univariable analyses, risk factors of aneurysm wall calcification were aneurysm size (OR 1.2, 95% CI 1.1-1.3), hypertension (OR 2.1, 95% CI 1.1-4.5), and at-risk morphology (OR 2.4, 95% CI 1.3-4.4). In multivariable analysis, independent risk factors for wall calcification were aneurysm size (OR 1.2, 95% CI 1.1-1.3) and hypertension (OR 2.8, 95% CI 1.2-6.6), but not at-risk morphology (OR 1.3, 95% CI 0.7-2.7). Aneurysm wall calcification could be ruled out in more than 90% of aneurysms smaller than 6 mm in both the derivation and validation cohorts.</p><p><strong>Conclusions: </strong>Aneurysm size and hypertension are independent risk factors of aneurysm wall calcification. The authors recommend preprocedural CT imaging in patients with a UIA ≥ 6 mm.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091909","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":"Volumetric courses of the intraosseous and meningeal components of osteomeningiomas after cyproterone acetate treatment withdrawal.","authors":"Paul E Constanthin, Virginie Montalibet, Mégane Le Quang, Morgan Ollivier, Olivier Saut, Annabelle Collin, Julien Engelhardt","doi":"10.3171/2025.4.JNS25252","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25252","url":null,"abstract":"<p><strong>Objective: </strong>Progestin exposure, such as with cyproterone acetate (CPA), could increase the risk of developing osteomeningiomas (OMs). This study investigated the volumetric dynamics of the meningeal and intraosseous components of these tumors and their correlation following CPA discontinuation.</p><p><strong>Methods: </strong>This retrospective study included 17 patients with 21 OMs diagnosed during ongoing CPA treatment. Volumes of the meningeal and intraosseous components of the OMs were measured at multiple time points. Volume dynamics over time were modeled using linear, exponential, power, and Gompertz tumor growth models. Hormone receptor expression in both components was evaluated via immunohistochemical analysis in the 4 tumors on which surgery was performed.</p><p><strong>Results: </strong>The Gompertz tumor growth model was the most accurate in fitting the data. After CPA cessation, the meningeal component showed volume reduction in 95% of tumors (a substantial decrease in 40% and a modest decrease in 55% of tumors). The intraosseous component exhibited sustained growth in all cases, characterized by three distinct dynamics: slowing growth (40%), linear growth (45%), and pseudo-exponential growth (15%). A significant correlation was observed between the volumetric courses in the two components (rho = 0.49, p = 0.03). Hormone receptor analysis revealed no differences in expression between the two components.</p><p><strong>Conclusions: </strong>While the meningeal and intraosseous components of OMs respond differently to CPA withdrawal, their growth dynamics remain correlated.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092049","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":"Association between the fresh frozen plasma-to-red blood cell transfusion ratio and neurological outcomes in patients with severe traumatic brain injury.","authors":"Shu Utsumi, Shingo Ohki, Nobuaki Shime","doi":"10.3171/2025.5.JNS25939","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25939","url":null,"abstract":"<p><strong>Objective: </strong>To date, no studies have focused on the fresh frozen plasma (FFP)-to-red blood cell (RBC) transfusion ratio in patients with severe traumatic brain injury (TBI). Herein, the authors investigated the relationship between the FFP-to-RBC ratio and neurological outcomes, including mortality, in patients with severe TBI (Glasgow Coma Scale [GCS] score < 9).</p><p><strong>Methods: </strong>This multicenter, retrospective, observational study used data from the Japan Trauma Data Bank from 2019 to 2023. The study included patients aged ≥ 18 years with severe TBI (defined as a GCS score < 9 and an Abbreviated Injury Scale [AIS] score > 2) without severe extracranial injury (AIS score > 2). The high-ratio group was defined as having an FFP-to-RBC ratio > 1, and the low-ratio group was defined as having a ratio of 1 or less. The association between the FFP-to-RBC ratio and outcomes was evaluated using propensity score-based inverse probability of treatment weighting. The primary outcome was in-hospital mortality, and the secondary outcome was a poor neurological outcome at discharge (defined as a Glasgow Outcome Scale score of 1-3).</p><p><strong>Results: </strong>A total of 1007 patients were included in the analysis. Compared with the low-ratio group, the high-ratio group showed no significant differences in in-hospital mortality (adjusted odds ratio [aOR] 0.91, 95% CI 0.69-1.22) or poor neurological outcome (aOR 1.12, 95% CI 0.76-1.64).</p><p><strong>Conclusions: </strong>The authors found no association between FFP-to-RBC transfusion ratio and neurological outcomes, including in-hospital mortality, in severe TBI.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091971","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":"Association between inflammatory score, coagulopathy, and hemorrhagic progression in patients with traumatic intraparenchymal hemorrhage: an exploratory study with interaction and mediation models.","authors":"Peng Zhang, Can Tang, Yinan Zhou, Zezheng Zheng, Yu Chen, Haoqi Ni, Weizhong Zhang, Zhiyuan Yan, Zequn Li, Kuang Zheng","doi":"10.3171/2025.5.JNS25281","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25281","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to incorporate biomarkers into an inflammatory score to improve risk prediction of coagulopathy and hemorrhagic progression of a contusion (HPC) in patients with traumatic intraparenchymal hemorrhage (tIPH), and to further explore the interaction and mediation effects within the chain of events.</p><p><strong>Methods: </strong>In this retrospective study, the medical records of patients with tIPH who received treatment at two centers from January 2019 to December 2021 were reviewed. Machine learning algorithms were applied for biomarker selection, and an inflammatory score was constructed. Multivariate logistic regression was used to assess the association between the inflammatory score, coagulopathy, and HPC. Measures on multiplicative and additive scales, as well as mediation effects, were subsequently estimated. Finally, by incorporating the inflammatory score, a hybrid model of HPC occurrence was established and validated.</p><p><strong>Results: </strong>A total of 451 patients (median age 54 years [IQR 45-66 years]) with tIPH were included in this study. The inflammatory score was developed using a combination of parameters, including the mean platelet volume, lactate dehydrogenase level, pan-immune-inflammation value, hemoglobin-to-red blood cell distribution width ratio, and C-reactive protein-to-albumin ratio. The multivariate analysis confirmed that the inflammatory score was independently associated with both coagulopathy and HPC. Additionally, the effect of a high inflammatory score on HPC occurrence was partially mediated by coagulopathy, demonstrating both direct mediation and mediated interaction effects. As a key mediator, coagulopathy accounted for 9.6% of the positive associations. Furthermore, incorporating the inflammatory score into the hybrid model demonstrated significant incremental predictive value across the training, internal, and external test sets.</p><p><strong>Conclusions: </strong>The inflammatory score was significantly associated with HPC, and this relationship was partially mediated by coagulopathy, with a potential synergistic interaction observed. The hybrid model improved HPC risk prediction.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054278","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":"Prevalence and risk factors of nonyield brain biopsy: a 21-year experience with robot-assisted stereotactic biopsies.","authors":"Xavier Schumacher, Benoit Hudelist, Luca Paun, Joseph Benzakoun, Marco Demasi, Meissa Hamza, Alexandre Roux, Alessandro Moiraghi, Angela Elia, Eduardo Parraga, Edouard Dezamis, Fabrice Chretien, Pascale Varlet, Catherine Oppenheim, Johan Pallud, Marc Zanello","doi":"10.3171/2025.2.JNS242273","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242273","url":null,"abstract":"<p><strong>Objective: </strong>Magnetic resonance imaging-based, robot-assisted stereotactic brain biopsy is increasingly used worldwide. However, large series reporting nonyield biopsy rates of robot-assisted biopsies are lacking in the literature. The aim of this study was to report a 21-year-long experience on MRI-based, robot-assisted stereotactic biopsy for brain lesions.</p><p><strong>Methods: </strong>The records from a single-center, retrospective, and consecutive collection of all adult patients undergoing MRI-based, robot-assisted stereotactic biopsy for a brain lesion in a tertiary neurosurgical center from December 2002 to January 2024 were reviewed.</p><p><strong>Results: </strong>A total of 911 patients (377 females, mean age at surgery 61.1 ± 16.7 years) were included. Of these patients, 15 (1.6%) had a nonyield biopsy. The nonyield biopsy rate remained stable over the 21-year-long study period (p = 0.224). The nonyield biopsy rate was significantly higher for neurological diseases (4/19, 21.5%) than infectious diseases (1/20, 5.0%) and tumors (10/872, 1.1%) (p < 0.001). There were significantly more nonyield biopsies for deep-seated lesions (8/261, 3.1%) than for superficial lesions (6/612, 1.0%) (p = 0.025) and non-contrast-enhanced lesions (6/99, 6.1%) than in contrast-enhanced lesions (9/797, 1.1%) (p < 0.001). Patients in the nonyield biopsy group had significantly smaller lesions on both contrast-enhanced 3D T1-weighted sequences (1.9 ± 2.2 vs 27.1 ± 29.5 cm3, p = 0.046) and FLAIR sequences (14.0 ± 17.0 vs 80.7 ± 73.3 cm3, p < 0.001). Preoperative corticosteroid administration (407/911, 44.7%; with the bias that corticosteroids were avoided in patients with suspected lymphoma), number of biopsy samples (mean 4.9 ± 2.4), neurosurgeon experience, and WHO classification versions were not associated with a higher risk of nonyield biopsy (p = 0.274, p = 0.053, p = 0.968, and p = 0.366, respectively).</p><p><strong>Conclusions: </strong>MRI-based, robot-assisted stereotactic biopsy led to a low rate of nonyield biopsy. Neurological disease, non-contrast-enhanced lesions, and deep-seated lesions were more at risk of nonyield biopsy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053717","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":"Technique, safety profile, and seizure outcomes after laser ablation for insular epilepsy: a multicenter cohort study.","authors":"Felix R Ekman, Jorge Gonzalez-Martinez, Silas Haahr Nielsen, Rune Rasmussen, Daniel Nilsson","doi":"10.3171/2025.5.JNS25221","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25221","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to assess the incidence of complications and seizure outcomes of laser interstitial thermal therapy (LITT) in the treatment of drug-resistant insular epilepsy, with a specific focus on complication rates after ablation of the posterior insula.</p><p><strong>Methods: </strong>The authors retrospectively analyzed the diagnostic workup and outcomes of all patients treated with LITT for the treatment of insular epilepsy at three centers. The hypothesis of insular origin was based on a combination of semiology, MRI, and FDG-PET/CT and/or magnetoencephalography in MRI-negative cases. Twelve of 14 patients underwent stereoelectroencephalography (SEEG), in which 3 patients underwent radiofrequency thermocoagulation following SEEG. Additionally, 2 patients underwent a secondary LITT procedure.</p><p><strong>Results: </strong>Following LITT, 9 patients (64.3%) achieved complete seizure freedom (International League Against Epilepsy [ILAE] class 1), 2 (14.3%) achieved seizure freedom but retained auras (ILAE class 2), and 3 (21.4%) saw no improvement in their epilepsy (ILAE class 5) at 6 months' follow-up. The patients who underwent a secondary LITT procedure achieved ILAE class 1 and 5, respectively. The overall transient complication rate was 18.8% for all 16 LITT cases and 21.4% for the 14 procedures that included ablation of the posterior insula. The permanent complication rate was 6.3% for all 16 LITT cases and 7.1% for 14 procedures that included ablation of the posterior insula.</p><p><strong>Conclusions: </strong>LITT is a safe and effective intervention for controlling insular epilepsy. Although the study is limited by its relatively short follow-up period, the seizure freedom rate observed in this cohort is comparable to that following open insular resection, with a low incidence of complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053754","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":"Functional status in long-term survivors after mapping-guided surgery for diffuse low-grade glioma: a consecutive series of 103 patients with a postoperative follow-up of at least 15 years.","authors":"Hugues Duffau","doi":"10.3171/2025.5.JNS25819","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25819","url":null,"abstract":"<p><strong>Objective: </strong>Despite a current overall survival (OS) > 20 years in patients undergoing surgery for diffuse low-grade glioma (LGG), there is no study focusing on functional status in long-term survivors. Here, a unique cohort of LGG patients followed for at least 15 years after mapping-guided resection is reported with analysis of long-lasting outcomes, especially the ability to work.</p><p><strong>Methods: </strong>Inclusion criteria were LGG patients operated on by the author using intraoperative mapping and follow-up ≥ 15 years after surgery. Long-term functional results were studied by assessing the Karnofsky Performance Scale (KPS) score and professional activity until the last evaluation. Two groups were compared: group 1 comprising patients who continued to work after surgery until the last follow-up, including those who eventually retired because of age; and group 2 comprising patients who did not return to work (RTW) after surgery or who stopped working because of their disease during follow-up.</p><p><strong>Results: </strong>This consecutive cohort included 103 patients (54 men [52.4%], 49 women [47.6%], mean ± SD age 37.8 ± 7.6 years), including 96 (93.2%) who experienced seizures (and 7 with incidentalomas [6.8%]). The mean preoperative tumor volume was 46.7 ± 35.6 cm3. Three patients (2.9%) had postoperative hemianopia deliberately generated. The mean postoperative KPS score was 94.8 ± 5.7, with 81 patients able to RTW (90%). The mean extent of resection (EOR) was 93.4% ± 7.4%, with 40 supratotal/total resections (38.8%). The mean residual tumor volume was 3.6 ± 5.6 cm3. There were 22 isocitrate dehydrogenase-mutated astrocytomas (21.4%) and 48 oligodendrogliomas (46.6%) (33 gliomas not otherwise specified [32%]). Ten patients (9.7%) received early radiotherapy, which was correlated to a lower rate of RTW (p = 0.05). Sixty-three patients (61.2%) underwent reoperation(s), with a total rate of neurological morbidity of 1.5% after 205 resections. The mean follow-up was 18.2 ± 2.9 years with an OS rate of 83.5%. Among the 86 patients who were still alive at final evaluation, 78 (90.7%) had KPS score ≥ 80. The proportion of patients with KPS score ≥ 80 at last follow-up was lower among irradiated patients (p = 0.005). The mean KPS score was lower before (p = 0.003) and 3 months after (p < 0.00001) surgery in group 2. In group 1, the preoperative (p = 0.046) and postoperative (p = 0.047) tumor volumes were smaller, with greater extent of resection (p = 0.03).</p><p><strong>Conclusions: </strong>This is the first series of LGG patients who lived ≥ 15 years after mapping-based surgery. These original data show long-term preservation of functional status, including professional activities, particularly in patients with early supratotal/total resection and without radiation therapy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054262","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":"Withdrawal of life-supporting treatment in severe traumatic brain injury.","authors":"Astrid C Hengartner, Paul Serrato, Shaila D Ghanekar, Michael DiLuna, Aladine A Elsamadicy","doi":"10.3171/2025.4.JNS243077","DOIUrl":"https://doi.org/10.3171/2025.4.JNS243077","url":null,"abstract":"<p><strong>Objective: </strong>Factors that influence the decision for withdrawal of life-supporting treatment (WLST) in patients with severe traumatic brain injury (sTBI) are incompletely understood.</p><p><strong>Methods: </strong>The authors conducted a retrospective cohort study using the 2016-2022 American College of Surgeons Trauma Quality Programs database to identify demographic and clinical factors associated with the decision for WLST in patients with sTBI. Multivariable logistic regression analysis was conducted. Hospital length of stay (LOS), intensive care unit LOS, number of days on a ventilator, and disposition outcomes were compared between patients with and without WLST.</p><p><strong>Results: </strong>A total of 202,160 patients with sTBI were identified, of whom 44,341 (21.9%) had WLST. The risk of WLST increased with age, with patients > 75 years of age (adjusted odds ratio [aOR] 5.82, 95% CI 5.51-6.14; p < 0.001) being at the highest risk of having WLST. Black (aOR 0.59, 95% CI 0.57-0.62; p < 0.001) and Hispanic (aOR 0.76, 95% CI 0.73-0.80; p < 0.001) patients had lower odds of WLST. Patients with Medicare had significantly higher odds of having WLST (aOR 1.39, 95% CI 1.33-1.45; p < 0.001) compared to patients with private insurance. The risk of WLST decreased with increasing Glasgow Coma Scale (GCS) scores; patients with a GCS score of 7 or 8 were the least likely to have WLST (aOR 0.65, 95% CI 0.62-0.67; p < 0.001). Patients with one (aOR 1.89, 95% CI 1.80-1.99; p < 0.001) or two (aOR 2.46, 95% CI 2.38-2.53; p < 0.001) nonreactive pupils were more likely to have WLST. Patients with no midline shift (aOR 0.58, 95% CI 0.56-0.59; p < 0.001) were less likely to have WLST. Patients with penetrating injuries (aOR 1.43, 95% CI 1.33-1.53; p < 0.001) had significantly higher odds of WLST compared to those with blunt injuries. On average, patients with WLST had a considerably shorter hospital LOS (6.2 ± 8.4 days vs 16.6 ± 20.3 days) compared with no-WLST patients.</p><p><strong>Conclusions: </strong>WLST in sTBI patients is associated with various features, including patient age, race, and insurance status. Further exploration is needed to fully understand the factors that impact the decision for WLST, with the aim of improving patient outcomes and care across socioeconomic divides.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053787","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}