Journal of neurosurgery最新文献

{"title":"AI assessment of surgical technical skill adaptation across depth levels in simulated tumor resection: a case series study.","authors":"Meryem Filiz, Recai Yilmaz, Trisha Tee, Puja Pachchigar, Xiaoyan Han, Daniel A Donoho, Rolando F Del Maestro","doi":"10.3171/2025.12.JNS251528","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251528","url":null,"abstract":"<p><strong>Objective: </strong>Surgical procedures involving varying tissue depths present challenges to surgeons regarding accessibility and precision, restricting instrument movement and increasing the risk of tissue injury. Understanding how experts navigate varying depths is essential, yet research on this issue is limited. Artificial intelligence (AI)-powered systems enable real-time analysis of 3D psychomotor performance during virtual reality simulation tasks. In this study, the authors evaluated performance in a complex brain tumor resection simulation, testing two hypotheses: 1) neurosurgeons' performance scores would remain at an expert level across varying depths, and 2) trainees' scores would decline as they navigated into deeper and more challenging areas.</p><p><strong>Methods: </strong>Participants included neurosurgeons (n = 14), senior trainees (n = 14), junior trainees (n = 10), and medical students (n = 12). Five left-handed participants were excluded to avoid confounding due to hand dominance, resulting in a final analyzed sample of 45 participants. The Intelligent Continuous Expertise Monitoring System, an AI-powered real-time performance assessment system, assessed surgical performance and measured metrics such as instrument tip separation distance, bleeding risk, healthy tissue injury risk, aspirator force applied, bipolar cautery force applied, and an overall composite score. An average score for each metric at each depth interval (0-15 mm) was calculated across expertise levels for statistical comparison in a retrospective single-center analysis.</p><p><strong>Results: </strong>Neurosurgeons maintained their performance score across varying depths, demonstrating their expertise. Senior trainees had lower scores with increased depth. Surprisingly, increased depth resulted in higher composite scores among medical students and junior trainees, as they had to adapt better instrument techniques in deeper surgical sites. However, their scores remained in the novice spectrum. There was an increasing trend in bleeding risk with greater depth regardless of the expertise level, indicating the more challenging nature of deeper sites.</p><p><strong>Conclusions: </strong>The unique responses observed at varying depths at each expertise level indicate the necessity for adaptive training modules that accommodate trainee skill set levels and individual learning curves, ensuring development of the competencies required for mastering challenging tasks.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816219","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":"Individualized multiparadigm mapping and standardized tablet-based task administration during awake craniotomy: associations with return to work and survival in diffuse gliomas.","authors":"Esteban Ramirez Ferrer, Kyle Noll, David S Sabsevitz, Guillaume Herbet, Juan P Zuluaga-Garcia, Priscella Asman, Katherine Connelly, Lucie Lavelle, Sally Raty, Shreyas Bhavsar, Chibawanye Ene, Sherise D Ferguson, Jeffrey S Weinberg, Hugues Duffau, Frederick F Lang, Sujit S Prabhu","doi":"10.3171/2025.12.JNS252009","DOIUrl":"https://doi.org/10.3171/2025.12.JNS252009","url":null,"abstract":"<p><strong>Objective: </strong>Protocols for intraoperative mapping during awake craniotomy vary widely. The aim of this study was to evaluate how the number and type of intraoperative neuropsychological paradigms administered via NeuroMapper, a tablet-based platform, during awake glioma surgery affect positive mapping rates, return to work (RTW), and oncological outcomes. Factors associated with the operative duration and early postoperative neurological deficits were of additional interest.</p><p><strong>Methods: </strong>This single-center retrospective study included patients with diffuse low- and high-grade gliomas who underwent awake craniotomy with NeuroMapper-guided mapping between 2018 and 2024. Primary outcomes were RTW, progression-free survival (PFS), and overall survival (OS); operative duration and early postoperative deficits were secondary outcomes. Covariate balancing propensity score (CBPS) analysis was used to address confounding by tumor grade, with all postweighting standardized mean differences < 0.10. A weighted logistic regression model assessed RTW, and CBPS-weighted Cox models assessed PFS and OS. Linear regression was used to analyze intraoperative variables, operative duration, and early postoperative deficits.</p><p><strong>Results: </strong>Of 189 patients included in the analysis, 65 had LGG (median age 39 years) and 124 had HGG (median age 56 years). Mapping complexity varied, with 1-6 tasks used (median 4). Weighted multivariate logistic regression analysis identified the following independent predictors of RTW: preoperative Karnofsky Performance Status score ≥ 80 (OR 1.37, p = 0.039), absence of recurrent disease (OR 0.30, p < 0.001), use of 5-6 paradigms (OR 1.54, p = 0.047), positive mapping (OR 2.41, p = 0.017), and subtotal resection (OR 4.43, p = 0.002). Intraoperative seizure, early postoperative deficit, and the resection technique were not significant. IDH mutation status was associated with improved PFS (HR 0.15, p < 0.001), while subtotal resection was associated with worsened PFS (HR 3.00, p < 0.001). Positive mapping was associated with better OS (HR 0.57, p = 0.04). The operative duration was unaffected by mapping variables but was longer in patients with obesity (β = 0.28, p = 0.038).</p><p><strong>Conclusions: </strong>Positive NeuroMapper-guided mapping of more diverse linguistic functions was associated with RTW and longer OS. Additionally, mapping complexity did not prolong surgery times, supporting potential standardization.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816215","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 of monotherapy intervention with long-term outcomes in Spetzler-Martin grade I and II arteriovenous malformations: a nationwide multicenter observational prospective cohort study.","authors":"Kexin Yuan, Zhipeng Li, Haibin Zhang, Heze Han, Ke Wang, Yahui Zhao, Qiang Hao, Xun Ye, Hengwei Jin, Dezhi Gao, Shibin Sun, Shuai Kang, Hao Wang, Youxiang Li, Shuo Wang, Yu Chen, Xiaolin Chen, Yuanli Zhao","doi":"10.3171/2025.12.JNS252197","DOIUrl":"https://doi.org/10.3171/2025.12.JNS252197","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to compare the long-term risk of hemorrhagic stroke and death between conservative management and monotherapy intervention in patients with Spetzler-Martin (SM) grade I and II brain arteriovenous malformations (AVMs).</p><p><strong>Methods: </strong>The authors included AVMs that underwent conservative management and monotherapy intervention between August 2011 and December 2021 from a nationwide multicenter prospective collaboration registry. Patients were categorized into unruptured and ruptured cohorts for comparison of long-term outcomes, with hemorrhagic stroke and death defined as primary outcomes and neurological status as a secondary outcome. The efficacy of various intervention strategies, including resection, embolization, and stereotactic radiosurgery (SRS), was also evaluated. Stratified analyses based on intervention strategies and different SM grade subtypes were conducted.</p><p><strong>Results: </strong>Of 4286 AVMs in the registry, 1013 patients were eligible for inclusion (387 with unruptured AVMs and 626 with ruptured AVMs). Overall, the intervention group showed a lower incidence of long-term hemorrhagic stroke and death compared with the conservative management group (0.43 vs 0.88 per 100 patient-years; adjusted HR [aHR] 0.61 [95% CI 0.24-1.52]), although this difference did not reach statistical significance. The results were similar in the two subgroups: aHR 0.95 (95% CI 0.28-3.18) for unruptured AVMs and aHR 0.29 (95% CI 0.06-1.32) for ruptured AVMs. Stratified analyses based on different intervention strategies and different SM grade subtypes showed that resection might benefit both unruptured (0.00 vs 0.79 per 100 patient-years, p = 0.006) and ruptured (aHR 0.12 [95% CI 0.03-0.53], p = 0.033) AVMs, while SRS might only benefit ruptured AVMs (aHR 0.04 [95% CI 0.01-0.34], p = 0.163). Embolization and SRS might not be beneficial for unruptured low-grade AVMs.</p><p><strong>Conclusions: </strong>In this observational prospective cohort study, intervention demonstrated benefit over conservative management in preventing long-term hemorrhagic stroke or death in patients with SM grade I or II AVMs. Among specific monotherapy interventions, resection proved favorable for both unruptured and ruptured SM grade I and II AVMs, while SRS might serve as a reasonable alternative in ruptured cases.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816221","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":"Establishment and external validation of prediction models for risk factors of cerebral hyperperfusion syndrome after combined revascularization in moyamoya disease based on meta-analysis and retrospective cohort studies.","authors":"Linfeng Liu, Peixuan Yang, Feng Liang, Tao Jiang, Weiping Xiao, Chuanyuan Tao, Lu Ma","doi":"10.3171/2025.12.JNS251691","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251691","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral hyperperfusion syndrome (CHS) is a complication affecting up to 50% of moyamoya disease (MMD) patients after combined revascularization. The aim of this study was to identify reliable CHS risk factors and develop predictive models.</p><p><strong>Methods: </strong>The authors performed a meta-analysis including studies on both combined and direct revascularization to capture potential risk factors, followed by a sensitivity analysis on the combined bypass group. They also performed a retrospective cohort analysis. Then three models were developed using the derivation cohort and externally validated. Significant variables from meta-analysis and logistic regression were used to construct nomograms, the performance of which was evaluated with receiver operating characteristic curves, calibration, and discrimination analyses.</p><p><strong>Results: </strong>Meta-analysis identified seven significant risk factors: age (effect 2.17, 95% CI 0.28-4.05; p = 0.025), hypertension (risk ratio [RR] 1.42, 95% CI 1.16-1.73; p = 0.001), surgery in the dominant hemisphere (RR 1.80, 95% CI 1.55-2.10; p < 0.001), preoperative hematocrit (effect 2.50, 95% CI 1.58-3.41; p < 0.001), intraoperative high arterial pressure (HAP) (RR 1.78, 95% CI 1.07-2.96; p = 0.026), postoperative white blood cell (WBC) count (effect 1.67, 95% CI 0.46-2.87; p = 0.007), and cerebral blood flow increase rate (effect 0.80, 95% CI 0.40-1.20; p < 0.001). Similar risk factors were confirmed in the retrospective cohort analysis. In a sensitivity analysis focusing on combined revascularization, fewer studies limited inclusion of factors such as temporary occlusion time, intraoperative HAP, postoperative WBC count, and postoperative blood pressure; age and hypertension also lost significance. In the validation cohort, the areas under the curve (AUCs) for model 1 (based on multivariate analysis) and model 2 (based on meta-analysis) were 0.83 (95% CI 0.77-0.90) and 0.84 (95% CI 0.77-0.91), with Youden indices of 0.54 and 0.53, respectively. Model 3 (based on sensitivity analysis) showed lower performance (AUC 0.76, 95% CI 0.66-0.85; Youden index 0.45).</p><p><strong>Conclusions: </strong>In the meta-analysis and cohort analysis, the authors identified risk factors for CHS following combined revascularization surgery in patients with MMD, and the nomogram constructed based on factors from meta-analysis demonstrated good predictive performance and clinical utility.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147816281","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":"Molecular markers of Rathke's cleft cysts and their clinical correlates: insights from experimental and human analyses.","authors":"Yuriko Sasaki, Hironori Bando, Maki Kanzawa, Noriaki Fukuhara, Michelle L Brinkmeier, Masaaki Yamamoto, Shin Urai, Yuma Motomura, Masaki Kobatake, Yuka Ohmachi, Yasutaka Tsujimoto, Yuka Oi-Yo, Masaki Suzuki, Naoki Yamamoto, Yuichi Fujita, Hiroshi Nishioka, Shozo Yamada, Hidenori Fukuoka, Genzo Iguchi, Sally A Camper, Wataru Ogawa","doi":"10.3171/2025.12.JNS251835","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251835","url":null,"abstract":"<p><strong>Objective: </strong>Rathke's cleft cysts (RCCs) are benign cystic lesions of the sellar and suprasellar regions that may cause hypopituitarism and arginine vasopressin (AVP) deficiency when symptomatic. A recent study with Isl-1 knockout mice identified six molecular markers-KRT8, TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1-as potential indicators of RCC pathogenesis. This study aimed to investigate the expression patterns of these markers in human RCCs and examine their association with clinical manifestations.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 108 histopathologically confirmed RCC cases resected between 2011 and 2023 at three medical centers. Immunofluorescence staining was performed for six markers, and expression profiles were correlated with clinical symptoms (hypopituitarism, AVP deficiency, visual disturbances, and headache), epithelial morphology, and MRI findings. Statistical analysis was conducted using chi-square or Fisher's exact tests.</p><p><strong>Results: </strong>KRT8 was expressed in 100% of RCC samples, while the expression rates for TUBA1A, SOX2, SOX9, FOXA1, and FOXJ1 were 90.7%, 75.9%, 76.9%, 55.6%, and 84.3%, respectively. SOX9 expression was significantly associated with single-layered epithelial morphology (p = 0.001). The absence of TUBA1A expression was significantly associated with AVP deficiency (p = 0.042), and FOXJ1 positivity was significantly associated with hypopituitarism (p = 0.040). No other significant associations were found between marker expression and imaging findings or other clinical symptoms.</p><p><strong>Conclusions: </strong>This study confirms that the six molecular markers identified in Isl-1 knockout mice are also expressed in human RCCs, with variable expression patterns. KRT8 and FOXA1 staining may aid in distinguishing RCCs from craniopharyngiomas. Moreover, FOXJ1 and TUBA1A expression profiles provide novel insights into the mechanisms underlying hypopituitarism and AVP deficiency, respectively. These findings highlight the potential diagnostic and prognostic utility of molecular markers in RCC management and underscore the need for further studies in asymptomatic and incidental cases.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774148","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":"CT-guided robotic placement of multiple convective delivery cannulas.","authors":"Mark A Damante, Russell R Lonser, Kyle VanKoevering, J Bradley Elder","doi":"10.3171/2025.12.JNS252131","DOIUrl":"https://doi.org/10.3171/2025.12.JNS252131","url":null,"abstract":"<p><strong>Objective: </strong>Emerging data indicate that the use of cranial robotics with CT guidance can provide an efficient and effective alternative for the simultaneous placement of multiple convection-enhanced delivery (CED) infusion cannulas to targeted regions in the brain. To assess the feasibility, efficiency, and accuracy of robot-assisted, CT-guided infusion cannula placement, this study simultaneously placed multiple bilateral CED cannulas to clinically relevant targets in cranial phantoms.</p><p><strong>Methods: </strong>Simultaneous bilateral CT-guided robot-assisted infusion cannula placement was performed in 3D-printed phantom heads. Surgical and imaging (CT and MRI) results were evaluated.</p><p><strong>Results: </strong>Five phantom heads were used in the study (30 targets, 6 targets per head). All cannulas were clearly identified on intraoperative CT and MRI. Targets were approached from frontal, parietal, and occipital entry points (10 targets each). The mean target depth was 72.9 (SD 15.1, range 50.2-97.8) mm. Based on CT imaging, the mean coronal error was 0.7 (SD 0.5, range 0.1-1.8) mm, sagittal error was 1.0 (SD 0.7, range 0.0-2.7) mm, and axial error was 0.6 (SD 0.5, range 0.1-1.8) mm. Based on MRI, the mean coronal error was 0.8 (SD 0.5, range 0.1-1.9) mm, sagittal error was 1.3 (SD 1.1, range 0.0-5.2) mm, and axial error was 0.9 (SD 0.7, range 0.1-2.7) mm. The mean radial error was similar comparing CT (0.4 [SD 0.7], range 0.01-2.3 mm) to MRI (0.6 [SD 0.7], range 0.02-2.9 mm). The time from initial target acquisition to placement of all cannulas was less than 30 minutes per phantom.</p><p><strong>Conclusions: </strong>Simultaneous CT-guided robotic insertion of multiple infusion cannulas was feasible, efficient, and precise. This technique could improve surgical efficiency for procedures involving targeted deliveries.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774137","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":"Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants for recurrent aggressive meningiomas: 5-year results from a prospective phase 2 trial.","authors":"Katriel E Lee, Joshua S Catapano, Jennifer M Eschbacher, C Leland Rogers, Joseph M Zabramski","doi":"10.3171/2025.12.JNS25868","DOIUrl":"https://doi.org/10.3171/2025.12.JNS25868","url":null,"abstract":"<p><strong>Objective: </strong>Maximal resection of meningiomas is the gold standard of therapy, yet recurrence following surgery alone is fairly common, particularly with more aggressive tumors. The authors explored the efficacy of treatment of recurrent, aggressive meningiomas with resection plus Cs-131 collagen tile brachytherapy (R+CTBT).</p><p><strong>Methods: </strong>This was a prospective, nonrandomized, single-center trial that enrolled patients with recurrent aggressive meningiomas between June 2013 and January 2018. All patients underwent maximal safe resection and placement of Cs-131 tiles for CTBT. Local progression, defined as tumor recurrence within 1.5 cm of the operative bed, was determined on follow-up imaging, and hazard ratios were determined to compare the efficacy of R+CTBT with prior treatment at the same site.</p><p><strong>Results: </strong>Twenty-nine recurrent aggressive meningiomas were treated in 27 patients with a median age of 66 (range 37-82) years. The WHO grade at the time of R+CTBT was grade 1 in 1 (3%) case, grade 2 in 26 (90%), and grade 3 in 2 (7%). The median radiographic follow-up was 34.8 (range 0.0-70.9) months. Local control at 48 and 60 months was 73% and 48%, respectively, following R+CTBT compared with 21% and 17% with prior treatment (HR 0.145, p < 0.001). Surgery-related complications occurred in 4 cases (14%), including 1 case (3%) with early postoperative infection and 3 (10%) with delayed wound breakdown and infection. Radiation brain injury occurred in 4 cases (14%), and each resolved with medical therapy.</p><p><strong>Conclusions: </strong>This study shows that resection combined with Cs-131 CTBT resulted in significantly improved local control with acceptable complications in patients with recurrent aggressive meningiomas when compared with the prior treatment at the same site.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774110","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 efficacy and safety of sublobectomy for glioblastoma: a propensity score-weighted study.","authors":"Chen Luo, Yanyan Song, Guanglin Zhu, Xiaoluo Zhang, Peng Wang, Junfeng Lu, Zhang Xiong, Sida Song, Dandan Cao, Xiaojia Liu, Hong Chen, Shuai Wu, Jinsong Wu","doi":"10.3171/2025.12.JNS251341","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251341","url":null,"abstract":"<p><strong>Objective: </strong>Sublobectomy is a modified surgical paradigm based on anatomical lobectomy, incorporating functional boundaries to extend resection safely, particularly for glioblastoma, a highly aggressive brain tumor. This study aimed to evaluate the efficacy and safety of sublobectomy and its prognostic value within the Response Assessment in Neuro-Oncology (RANO) categories for extent of resection.</p><p><strong>Methods: </strong>Building on their clinical practice, the authors established a sublobectomy standard defined by lobe-specific anatomical boundaries complemented by functional mapping limits and applied it across the frontal, temporal, parietal, and occipital lobes. In this retrospective single-center study, 989 IDH-wildtype glioblastoma cases were analyzed, and 401 met the anatomical criteria for sublobectomy. After excluding cases with residual contrast-enhancing (CE) tumor or incomplete postoperative chemoradiotherapy, 331 cases were included. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to minimize confounding biases. Survival outcomes were assessed using Kaplan-Meier survival analysis and Cox proportional hazards models, while functional outcomes were evaluated using Karnofsky Performance Status, Boston Diagnostic Aphasia Examination, and Eastern Cooperative Oncology Group scores.</p><p><strong>Results: </strong>Sublobectomy significantly improved overall survival (OS) and progression-free survival (PFS) compared to CE tumor resection (median OS: 25.6 vs 18.1 months [p < 0.001], median PFS: 17.0 vs 12.0 months [p < 0.001]). These findings remained consistent after IPTW and PSM analyses. Functional assessments showed no additional risks to quality of life, physical performance, or language function. In RANO class 1 patients, sublobectomy also significantly improved OS and PFS. Subgroup analyses revealed greater survival benefits in patients with TERTp mutations or MGMTp methylation. Maximal safe edema resection emerged as a key factor for improved outcomes.</p><p><strong>Conclusions: </strong>Sublobectomy is a functionally optimized supramaximal resection strategy with favorable safety and significant survival benefits for glioblastoma patients.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774065","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":"Multimodal detection of idiopathic normal pressure hydrocephalus: neuropsychological assessment, radiological correlates of corpus callosum morphology, and CSF outflow resistance.","authors":"Vicente Vanaclocha, Natalia Navarro-Peris, Nieves Saiz-Sapena, Esther Tercero-Atencia, Leyre Vanaclocha","doi":"10.3171/2025.12.JNS251883","DOIUrl":"https://doi.org/10.3171/2025.12.JNS251883","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate associations between the corpus callosum angle (CCA), corpus callosum splenial angle (CCSA), and resistance to CSF outflow (Rout) with neuropsychological performance in patients who had suspected idiopathic normal pressure hydrocephalus (iNPH), and to assess their predictive value for diagnosis and postoperative cognitive outcomes following ventriculoperitoneal shunt placement.</p><p><strong>Methods: </strong>This prospective observational study included 74 patients (39 male, mean age 73.6 years) who were evaluated for iNPH between 2019 and 2022 at a single institution. All patients underwent MRI-based measurement of the CCA and CCSA, the Katzman test for Rout, and a comprehensive neuropsychological battery. Patients were grouped by CCA size (< 90°, 91°-109°, and > 110°), CCSA size (< 60°, 61°-79°, and > 80°), and Rout (≥ 12 mm Hg and < 12 mm Hg). Group comparisons were performed using nonparametric tests, and logistic regression was applied to identify neuropsychological predictors of elevated Rout.</p><p><strong>Results: </strong>Lower CCA values were associated with trends toward poorer performance in imitation apraxia, visual gnosis, and Mini-Mental State Examination (MMSE) scores, although none reached statistical significance after correction for multiple comparisons. Elevated Rout (≥ 12 mm Hg) was significantly associated with better MMSE scores (adjusted p = 0.029), while other domains, including symbolic apraxia, rhythm reproduction, and confrontation naming, showed consistent trends but without statistical significance after correction. A logistic regression model that incorporated MMSE and rhythm reproduction predicted elevated Rout with 93.5% sensitivity and an area under the curve of 0.86. Postoperative cognitive improvements were modest and variable; however, long-term follow-up revealed sustained functional gains in selected patients, particularly those with elevated Rout and preserved preoperative cognitive function.</p><p><strong>Conclusions: </strong>CCA and Rout were independently associated with distinct cognitive profiles in patients with suspected iNPH. In particular, Rout demonstrated predictive value for preserved global cognition. Integrating anatomical, physiological, and neuropsychological markers might enhance diagnostic accuracy and improve patient selection for ventriculoperitoneal shunt placement.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774151","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":"Peritruncal hematoma volume: is it a neglected prognostic marker in aneurysmal subarachnoid hemorrhage?","authors":"Milad Neyazi, Igor Fischer, Daniel Weiss, Marius Vach, Kerim Beseoglu, Sajjad Muhammad, David Wasilewski, Jan F Cornelius, Katharina Faust, Björn B Hofmann","doi":"10.3171/2025.12.JNS252313","DOIUrl":"https://doi.org/10.3171/2025.12.JNS252313","url":null,"abstract":"<p><strong>Objective: </strong>Radiological severity scores for aneurysmal subarachnoid hemorrhage (aSAH), such as the modified Fisher scale (mFS), focus on supratentorial blood components. However, peritruncal blood is frequently present but remains underrepresented in current grading systems, despite the functional relevance of the brainstem. In the present study, authors aimed to investigate the association among peritruncal blood volume, aSAH-related complications, and clinical outcomes.</p><p><strong>Methods: </strong>In this retrospective single-center study, aSAH patients with baseline CT imaging in the period from 2012 to 2022 were analyzed. Hematoma volumes in predefined peritruncal cisterns (interpeduncular, prepontine, premedullary, and magna) and ventricles (third and fourth) were manually segmented, and both individual and cumulative peritruncal volumes were analyzed. Associations with complications (ventriculoperitoneal shunt [VPS] dependency, macrovasospasm, and delayed cerebral ischemia [DCI]) and functional outcome (modified Rankin Scale score at discharge and 6 months) were assessed and compared to Fisher scale (FS) and mFS grades.</p><p><strong>Results: </strong>Among the 675 patients included in this study, peritruncal cisternal and ventricular blood volumes were significantly associated with VPS dependency and functional outcome and had weaker associations with DCI. Across radiological parameters, cumulative peritruncal hematoma volume had a stronger association with functional outcome at discharge and 6 months than the Fisher-based scales; however, absolute model fit remained modest (pseudo-R2 0.141 and 0.139 vs FS 0.078 and 0.067; and vs mFS 0.098 and 0.090). Associations persisted in patients with low FS grades (≤ 2) and in those with anterior circulation aneurysms.</p><p><strong>Conclusions: </strong>Peritruncal blood volume is independently associated with outcome after aSAH and may be a clinically relevant marker in aSAH. Incorporating peritruncal components into current supratentorially based grading systems may enhance their predictive utility. These exploratory findings warrant prospective multicenter validation, and there is currently work focused on an \"extended Fisher\" approach that integrates infratentorial compartments.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147774075","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}