Journal of neurosurgery最新文献

{"title":"A national study of neurosurgical residency competency development.","authors":"Syed I Khalid, Ankit I Mehta, Gursant Atwal, Sean O Hogan, Yoon Soo Park, Fady T Charbel","doi":"10.3171/2025.4.JNS243272","DOIUrl":"10.3171/2025.4.JNS243272","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate milestone progression across 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies and 20 subcompetencies among neurosurgery residents, focusing on the attainment of level 4 proficiency by the final postgraduate year (PGY 7), and to identify patterns of co-occurring deficiencies.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted using national ACGME Milestone data from 2478 neurosurgery residents across 120 programs in the United States, covering 2018 to June 2022 evaluations. Semiannual milestone scores were analyzed using mean, standard deviation, median, and interquartile range. The proportion of residents not achieving level 4 by PGY 7 was assessed, and co-occurring deficiencies were identified through pairwise analysis and the variance-to-mean ratio (VMR).</p><p><strong>Results: </strong>Residents demonstrated significant progression from PGY 1 to PGY 7, with mean scores increasing from 1.2-1.7 in PGY 1 to 4.20-4.36 by PGY 7. By PGY 7, 445 of 997 residents (44.6%) had not achieved level 4 in at least one subcompetency. Patient Care (PC) had the highest proportion below level 4 (35.5%), particularly in specialized areas such as Surgical Treatment of Epilepsy and Movement Disorders (mean 4.08 ± 0.48) and Pain and Peripheral Nerve Disorders (mean 4.05 ± 0.49). Pairwise analysis revealed co-occurrences among specialized PC subcompetencies and between Reflective Practice and technical competencies. VMR analysis showed substantial variability in subcompetency attainment across programs.</p><p><strong>Conclusions: </strong>Neurosurgery residents show robust milestone progression, yet gaps persist in specialized clinical skills and self-assessment practices, often aligning with subspecialties where fellowship training is common. Residency programs might need to enhance exposure or adjust competency expectations. Integrated educational strategies, including targeted interventions and specialized procedural training, are recommended to ensure all residents achieve level 4 competency, preparing them for independent practice.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336700","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":"Erratum. Reduced time to imaging, length of stay, and hospital charges following implementation of a novel postoperative pathway for craniotomy.","authors":"Omar Arnaout","doi":"10.3171/2024.8.JNS222123a","DOIUrl":"10.3171/2024.8.JNS222123a","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144336701","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":"Development of a virtual dissection environment integrated into cadaveric dissection for skull base anatomy education.","authors":"Tatsuya Uchida, Taichi Kin, Yuanzhi Xu, Satoshi Kiyofuji, Naoyuki Shono, Yukinari Kakizawa, Aaron Cohen-Gadol, Juan C Fernandez-Miranda, Nobuhito Saito","doi":"10.3171/2025.3.JNS243264","DOIUrl":"https://doi.org/10.3171/2025.3.JNS243264","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The authors sought to develop and integrate a novel virtual dissection (VD) environment using high-fidelity microanatomical 3D computer graphics (HFM-3DCG) with cadaveric dissection (CD) to enhance the anatomical understanding, procedural confidence, and overall satisfaction among neurosurgical residents for skull base approaches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;HFM-3DCG, designed to replicate complex skull base structures such as vessels, nerves, dura mater, and ligaments with high fidelity, was used to construct a VD environment including three skull base approaches: Dolenc, anterior petrosal, and presigmoid. The VD models enabled interactive visualization of the anatomical structures and real-time procedural simulations. Six neurosurgical residents performed all three approaches using VD integrated into the CD workflow. VD was used for confirming the anatomical landmarks in real time. Each approach included a stepwise progression from craniotomy to intradural exposure, with a maximum time limit of 150 minutes. After completing the procedures, participants evaluated the integrated learning environment using satisfaction and confidence questionnaires. Supervisors conducted objective assessments focusing on the residents' ability to accurately identify anatomical landmarks, comprehend spatial relationships, and execute procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A novel VD environment was developed using HFM-3DCG and integrated with CD to create a comprehensive anatomical learning environment. VD allowed learners to simulate key surgical techniques, such as drilling and brain retraction, thus enhancing procedural understanding. The integrated environment demonstrated high functionality, enabling residents to enhance their learning experience during CD. Satisfaction ratings were the highest for VD's visual accuracy, ease of integration with CD, and usefulness in skull base approaches. The confidence ratings indicated improvements in understanding 3D anatomical relationships, identifying critical structures, and performing procedures. Objective evaluations revealed an enhanced understanding of the 3D relationships between the anatomical structures. The median VD usage time was less than 20 minutes per approach, demonstrating the efficiency of CD augmentation without significant time extensions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The new VD environment using HFM-3DCG provided high-fidelity and interactive anatomical visualization, enabling enhanced learning experiences. This study demonstrated the feasibility and benefits of integrating VD with CD for skull base surgical training. Procedural simulations, including drilling and brain retraction, offer realistic practical opportunities, further enriching anatomical understanding. This integrated environment can improve performance in actual surgeries by fostering a deeper comprehension of complex anatomical structures and procedures, offering a significant potential for","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293902","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":"Erratum. Effectiveness of 2-methoxyestradiol in alleviating angiogenesis induced by intracranial venous hypertension.","authors":"Liang Chen","doi":"10.3171/2025.5.JNS15159a","DOIUrl":"https://doi.org/10.3171/2025.5.JNS15159a","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293903","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":"Tribute to George Samandouras, MD (1964-2024).","authors":"Costas G Hadjipanayis","doi":"10.3171/2025.3.JNS242107","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242107","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293919","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":"Afferent and efferent fiber systems of the human amygdala: anatomical, pathophysiological, and clinical significance.","authors":"Pinar Kuru Bektasoglu, Aisha Ghare, Cimen Elias, Zeynep Firat, Abuzer Gungor","doi":"10.3171/2025.3.JNS241544","DOIUrl":"https://doi.org/10.3171/2025.3.JNS241544","url":null,"abstract":"<p><strong>Objective: </strong>The amygdaloid body, also known as the amygdaloid nuclear complex or amygdala, is a collection of multiple interconnected diencephalic gray matter nuclei and is in turn part of the larger limbic nuclear complex. Important commissural and projection fibers are interconnected with the amygdala. The aim of this study was to present original anatomical and radiological studies of the amygdala and a thorough review of its anatomical connections, spatial topography, functional roles, and associated clinical syndromes, specifically tailored for relevance to neuroclinicians.</p><p><strong>Methods: </strong>In this study, the authors investigated the afferent and efferent fiber pathways of the amygdala with white matter fiber dissection and diffusion tensor tractography. Functional and clinical syndromes associated with these fiber pathways were also reviewed in this study.</p><p><strong>Results: </strong>The amygdala can be classified into three main nuclei groups: laterobasal (deep), corticomedial, and superficial (cortical) nuclei. The ansa peduncularis, ansa lenticularis, stria terminalis, and stria medullaris thalami are the main amygdalofugal pathways. In this study, the authors showcase these fiber pathways via the white matter fiber dissection technique and diffusion tensor tractography. The functional roles and clinical significance of these pathways are also reviewed. The amygdala has a role in cognitive functions (i.e., processing of unpleasant and frightful stimuli, emotion regulation, classic conditioning, reward processing, social cognition, and memory formation). It has been reported that positive responses are obtained by targeting the amygdala with deep brain stimulation in conditions such as autism, anxiety, and depression.</p><p><strong>Conclusions: </strong>Comprehensive neuroanatomical knowledge of the amygdala and its afferent and efferent pathways will avoid iatrogenic damage to these delicate structures.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293900","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":"Evaluating longitudinal changes of gait parameters following shunt placement in patients with idiopathic normal pressure hydrocephalus.","authors":"Rahul Kumar, Abdelrahman M Hamouda, Zach Pennington, Maria D Astudillo Potes, Mahnoor Shafi, Hana Hallak, Sandesh G Bhat, Asghar Rezaei, Ignacio Jusué-Torres, Jonathan Graff-Radford, David T Jones, Hugo Botha, Jeremy K Cutsforth-Gregory, Farwa Ali, Petrice M Cogswell, Kenton R Kaufman, Benjamin D Elder","doi":"10.3171/2025.3.JNS241416","DOIUrl":"https://doi.org/10.3171/2025.3.JNS241416","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait deterioration, cognitive disturbances, and urinary incontinence. Gait deficits pose safety hazards due to frequent falls, yet objective investigations of gait improvement following ventriculoperitoneal shunt (VPS) placement are limited. Therefore, the aim of this study was to assess objective improvement in gait parameters for patients with iNPH after VPS placement.</p><p><strong>Methods: </strong>All patients treated with a VPS for iNPH by the senior author at a single tertiary care center from December 2017 to January 2023 were retrospectively reviewed. Patients who underwent detailed motion analysis testing before surgery with > 1 follow-up assessment were included. Analyzed parameters included gait velocity, gait cadence, stride length, stride width, gait stability ratio, total support, and single support. Time-dependent linear mixed-effects models and generalized additive mixed-effects models (GAMMs) were used to model short-term and longitudinal gait parameter changes, respectively.</p><p><strong>Results: </strong>A total of 212 patients (137 male, median age was 75.2 years) who underwent VPS placement for iNPH were included, with a total of 747 gait analyses performed at a median last-gait analysis follow-up duration of 12.0 months. Statistically significant changes in all gait parameter values were seen between the preoperative time point and first postoperative follow-up (within 3 months) time point (paired Wilcoxon p < 0.001), with a statistically significant majority of patients experiencing improvement (binominal p < 0.0001). Longitudinal analyses using a GAMM showed increased gait velocity, single support, and stride length, with decreased stability ratio, step width, and total support at early time points, while a plateau was achieved around 6 months.</p><p><strong>Conclusions: </strong>A detailed gait analysis demonstrated significant improvements in objective ambulation metrics, particularly in the gait velocity, stride length, and gait stability ratio, following VPS placement in patients with iNPH. Most patients maintained marked improvement from baseline to the last follow-up assessment, although a plateau of the benefit was experienced over longer follow-up.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293904","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":"Platelet transfusions and outcomes following minimally invasive intracerebral hemorrhage evacuation.","authors":"Muhammad Ali, Colton Smith, Muhammad Amjad Hameed, Muhammad Murtaza-Ali, Anthony Lin, Sabastian Hajtovic, Vikram Vasan, Ian C Odland, Braxton Schuldt, Margaret H Downes, Eugene I Hrabarchuk, Roshini Kalagara, Bahie Ezzat, Devarshi Vasa, Fernanda Carvalho Poyraz, Nek Asghar, J Mocco, Christopher P Kellner","doi":"10.3171/2025.2.JNS241492","DOIUrl":"https://doi.org/10.3171/2025.2.JNS241492","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Minimally invasive evacuation has emerged as a promising treatment paradigm for spontaneous intracerebral hemorrhage (ICH). Preoperative platelet transfusion to reduce the risk of perioperative hemorrhage remains controversial, given that it can increase clot fibrosity, leading to a more difficult-to-resect hematoma and worse clinical outcome without appreciably reducing the risk of perioperative hemorrhage. To evaluate this hypothesis, the authors developed and prospectively applied a qualitative scale rating the consistency of intraoperative hematoma and then assessed the association of the scale with platelet transfusion, evacuation percentage, functional outcome, and postoperative rebleeding.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients presenting with spontaneous supratentorial ICH at a large urban healthcare system from October 2017 to December 2021 were evaluated for surgical evacuation. Criteria for study inclusion comprised age ≥ 18 years, premorbid modified Rankin Scale (mRS) score ≤ 3, hematoma volume ≥ 15 mL, and National Institutes of Health Stroke Scale score ≥ 6. Intraoperatively, clots were prospectively assigned a consistency score, ranging from 1 to 5. A score of 1 indicated a completely fluid hematoma; a score of 2, a hematoma with solid components requiring only aspiration for removal; and scores of 3 and 4, a hematoma with solid components requiring morcellation in addition to aspiration for removal. If ≤ 50% of the clot required morcellation, a score of 3 was assigned. If &gt; 50% of the clot required morcellation, a score of 4 was assigned. A score of 5 indicated fibrous clot resistant to both aspiration and morcellation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 142 consecutive patients. The median clot consistency score was 2 (IQR 2-3). A higher clot consistency score was associated with a lower evacuation percentage, which in turn was associated with worse 9-item modified Rankin Scale questionnaire (mRS-9Q) scores at 6 months. The only preoperative factors independently associated with clot consistency were platelet transfusion (β = 0.92, 95% CI 0.21-1.64, p = 0.01) and anticoagulant reversal (β = 1.27, 95% 0.60-1.94, p = 0.0003). Specifically, the median clot score was 4 (IQR 2-5) and 4 (IQR 2-4) among these patients, respectively, but only 2 (IQR 2-2) among the remainder of the cohort (p &lt; 0.0001). Platelet transfusion and anticoagulant reversal were in turn associated with greater residual hematoma volumes, lower evacuation percentages, and worse 6-month mRS-9Q scores but not with lower rates of postoperative rebleeding. Specifically, the median 6-month mRS-9Q score was 6 (IQR 4-6) and 5 (IQR 4-6) among these patients but 3 (IQR 3-5) among the remainder of the cohort (p &lt; 0.0001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In a prospective cohort of 142 patients undergoing minimally invasive endoscopic ICH evacuation, the preoperative administration of platelets was associated with increased ","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293908","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 endoscopic third ventriculostomy with stereotactic prepontine stenting in patients with aqueductal stenosis.","authors":"Moritz Ueberschaer, Katja Wirthensohn, Sebastian Niedermeyer, Robert Forbrig, Niklas Thon, Mathias Kunz, Michael Schmutzer-Sondergeld","doi":"10.3171/2025.2.JNS242984","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242984","url":null,"abstract":"<p><strong>Objective: </strong>The standard treatment for noncommunicating hydrocephalus is endoscopic third ventriculostomy (ETV). An alternative procedure is the stereotactic implantation of a shunt catheter through the ventricles into the prepontine cistern, which serves as a stent (STS). This procedure may reduce the risk of stoma occlusion. The aim of this study was to compare the surgical and clinical results of both procedures.</p><p><strong>Methods: </strong>Patients with aqueductal stenosis treated by either ETV or STS from January 2013 to July 2024 were included in this single-center retrospective study. Patient records were searched for indication, procedural data, complications, and clinical outcomes. In addition, available MR images were analyzed for the Evans index, basilar artery to clivus distance, and ventricular width. The parameters were compared between ETV and STS groups.</p><p><strong>Results: </strong>STS was performed in 50 patients with a mean age of 46 years and ETV in 97 patients with a mean age of 36 years. STS was carried out more frequently in patients with secondary aqueductal stenosis due to a tumor (66% vs 21%), while ETV was conducted more frequently in patients with primary aqueductal stenosis (76% vs 26%). The distance between the basilar tip and clivus was significantly smaller in the STS group (2.8 vs 3.7 mm, p = 0.0007). The most common symptoms before surgery in both groups were headaches (48%), cognitive impairment (46%), and gait disorder (48%). Both procedures resulted in significant improvement of symptoms. There was no significant difference in the number of revision surgical procedures due to infection or bleeding (STS 8% vs ETV 4%) or insufficiency of the hydrocephalus treatment (STS 4% vs ETV 13%, p = 0.09). Subgroup analyses that excluded newborns and stratified results by etiology of aqueductal stenosis had no effect on the results.</p><p><strong>Conclusions: </strong>The safety and efficacy of both surgical procedures are comparable. The selection of the surgical approach must be made on an individual basis.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293901","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. Multimodal minimally invasive therapies for CSDH with membranous complexity.","authors":"Zhili Qiao, Cheng Wang, Xiaolin Du","doi":"10.3171/2025.3.JNS25595","DOIUrl":"https://doi.org/10.3171/2025.3.JNS25595","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293907","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}