Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Advanced MRI in TN diagnosis and treatment.","authors":"Luigi Albano, Silvia Basaia, Lina Raffaella Barzaghi, Edoardo Pompeo, Filippo Valtorta, Antonella Castellano, Andrea Falini, Federica Agosta, Pietro Mortini, Massimo Filippi","doi":"10.3171/2025.6.JNS251467","DOIUrl":"https://doi.org/10.3171/2025.6.JNS251467","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313090","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":"Characteristics and in-hospital outcomes of patients presenting to a level 1 trauma center classified under the modified Brain Injury Guidelines.","authors":"Kevin T Kim, Steven K Yarmoska, Cara Lomangino, Callum D Dewar, Matthew Hentschel, Maureen Scarboro, Carla Aresco, Deborah M Stein, David Efron, Gary Schwartzbauer","doi":"10.3171/2025.6.JNS25342","DOIUrl":"https://doi.org/10.3171/2025.6.JNS25342","url":null,"abstract":"<p><strong>Objective: </strong>The Brain Injury Guidelines (BIG) were modified in 2020 to improve efficiency and safety in triage decision-making. The aim of this study was to present characteristics and in-hospital outcomes of patients classified under category 1 of the modified BIG (mBIG 1).</p><p><strong>Methods: </strong>A retrospective review of patients presenting with acute traumatic brain injury (TBI) to a level 1 trauma center between 2019 and 2023 was performed. Patients meeting clinical and radiographic criteria for mBIG 1 were identified. An additional cohort of patients was identified who were taking 81 mg of aspirin once daily (ASA81) before the hospital, but who otherwise met mBIG 1 criteria. Summary statistics and univariate analyses were performed.</p><p><strong>Results: </strong>Three hundred three patients were identified and classified as mBIG 1. The mean patient age was 54.45 (SD 1.17) years and 41.3% were female. There were 144 patients (47.5%) who transferred from an outside hospital. The median admission Glasgow Coma Scale score was 15 (interquartile range [IQR] 15-15). Patients underwent an average of 2.28 (SD 0.03) CT scans. There were 123 (40.6%), 18 (5.9%), and 126 (41.6%) patients with subdural hematoma, intraparenchymal hemorrhage, and subarachnoid hemorrhage, respectively, with 36 patients (11.9%) presenting with multiple hemorrhages. Eleven patients (3.6%) experienced hemorrhage progression. No patient underwent neurosurgical intervention. The mean Injury Severity Score was 13.12 (SD 7.04). The median hospital length of stay (LOS) was 1.01 (IQR 0.37-4.56) days, 75.2% of patients were discharged home, 24.1% were discharged to rehabilitation, and 0.7% died in the hospital. An additional 25 patients were identified who were taking ASA81 prehospital, but otherwise met mBIG 1 criteria. None of these patients underwent neurosurgical intervention and there were no in-hospital deaths. One patient (4.0%) taking ASA81 experienced progression of their hemorrhage but still met mBIG 1 criteria. When compared to the mBIG 1 cohort, the aspirin cohort was significantly older (p < 0.001), but otherwise showed no differences in demographic, clinical, or radiographic variables. The combined mBIG 1 + aspirin cohort was stratified by hemorrhage progression (n = 12). Hospital LOS was significantly greater in the progression cohort (p = 0.017) and fewer patients were discharged home (p = 0.001). There was no difference in age, hypertension, admission mean arterial pressure, platelet count, international normalized ratio, partial thromboplastin time, hemorrhage pattern, and aspirin use between the groups.</p><p><strong>Conclusions: </strong>Hemorrhage progression was rare, including cases in which patients were receiving prehospital low-dose aspirin therapy. More data are needed that evaluate the role of low-dose aspirin in the triage of patients with mild TBI.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274894","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":"Near-total resection in sporadic vestibular schwannoma: is there a volumetric threshold for a win-win scenario?","authors":"Daniela Stastna, Robert Macfarlane, Richard Mannion, Patrick Axon, Manohar Bance, Neil Donnelly, James R Tysome, Mathew R Guilfoyle, Daniele Borsetto, Simon Duke, Sarah Jefferies, Indu Lawes, Juliette Buttimore, Ari Ercole, Jonathan P Coles","doi":"10.3171/2025.6.JNS242466","DOIUrl":"https://doi.org/10.3171/2025.6.JNS242466","url":null,"abstract":"<p><strong>Objective: </strong>Surgical management of large vestibular schwannoma (VS; Koos grades III and IV) requires a balance between the maximum extent of resection and the best functional preservation. The primary objective of this study was to determine the volumetric threshold of the VS residual tumor at risk of progression after incomplete resection. The secondary objective was to identify other risk factors of regrowth after incomplete resection.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent incomplete resection of sporadic VS at a single center from January 2008 to December 2018. The inclusion criteria were: adult age, large single sporadic VS, incomplete resection, and follow-up of > 5 years. Quantitative 3D volumetry was assessed on pre- and postoperative contrast-enhanced T1-weighted MRI using semiautomated segmentation. The volumetric criteria for residual tumor were < 250 mm3 for near-total resection (NTR) and < 2 cm3 for subtotal resection (STR). Univariate and multivariate logistic regression analyses were performed to assess predictors of regrowth after incomplete resection. A residual volume cutoff for risk of regrowth was determined using the Youden index via area under the curve analysis.</p><p><strong>Results: </strong>The cohort included 119 patients (60 female, median age 58 years) who were categorized into 3 subgroups based on the residual VS according to 3D volumetry: NTR, STR, and partial resection (PR). NTR achieved the best long-term tumor control. Kaplan-Meier progression-free survival rates at 2, 5, and 10 years were 98%, 97%, and 95% for the NTR group; 69%, 56%, and 56% for the STR group; and 20%, 0%, and 0% for the PR group, respectively (p < 0.0001). The cutoff residual volume at risk of growth was 200 mm3, with sensitivity of 95% (95% CI 74%-99%) and specificity of 77% (95% CI 68%-85%, p < 0.001). Moreover, good facial nerve outcomes (House-Brackmann grades I and II) were best achieved with PR (100%), followed by STR (96%) and NTR (90%). In the univariate analysis, the risk factors for regrowth of residual tumor were cystic morphology, residual volume, and residual location (internal auditory canal, cisternal segment, and brainstem combined). The multivariate model identified the volume and location of residual as risk factors (p < 0.0001).</p><p><strong>Conclusions: </strong>These findings suggest that limited NTR (< 250 mm3) offered an excellent compromise, with long-term tumor control comparable to that of radical resection while preserving superior functional preservation. The authors hope to stimulate discussion toward a unified volumetrically established classification of incomplete resections, allowing for cooperation in future multicenter studies.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274875","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":"Multiple arachnoid membrane opening to promote angiogenesis in adult patients with moyamoya disease after combined bypass surgery: a multicenter randomized controlled clinical trial.","authors":"Songtao Qi, Tinghan Long, Liming Zhao, Erming Zeng, Chengliang Mao, Cong Ling, Jianjian Zhang, Zhenyu Zhang, Guozhong Zhang, Mingzhou Li, Shichao Zhang, Yunyu Wen, Huibin Kang, Peng Li, Hui Wang, Yabo Huang, Wenfeng Feng, Gang Wang","doi":"10.3171/2025.5.JNS25385","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25385","url":null,"abstract":"<p><strong>Objective: </strong>In adult patients with moyamoya disease (MMD), insufficient postoperative collateral formation is usually seen after combined bypass surgery. The arachnoid membrane, a critical anatomical barrier between extracranial and intracranial vascular systems, has an unclear role in postoperative angiogenesis. The aim of this study was to investigate whether intraoperative arachnoid membrane opening enhances angiogenesis in adult patients undergoing combined bypass surgery for MMD.</p><p><strong>Methods: </strong>This multicenter, prospective, randomized controlled trial (Membrane Opening to Promote Angiogenesis in Adult MMD [MOPOAM]) was conducted across 8 institutions in China. Between June 2022 and August 2023, 104 patients diagnosed with MMD through digital subtraction angiography were randomly assigned to two groups: one group underwent arachnoid opening (n = 51), while the other group had arachnoid preservation (n = 53). The primary endpoint was the rate of good angiogenesis (Matsushima grade A and B) assessed 6-12 months postoperatively, and the secondary endpoint was the incidence of surgical complications within 1 month postsurgery.</p><p><strong>Results: </strong>All 104 patients completed the study. The rate of good angiogenesis was 54.9% in the arachnoid opening group and 64.2% in the arachnoid preservation group, with no significant difference between groups (OR 1.470, 95% CI 0.669-3.229; p = 0.337). Postoperative complications were observed in 2 patients (3.9%) in the arachnoid opening group and in 5 patients (9.4%) in the arachnoid preservation group, showing no significant difference (OR 2.552, 95% CI, 0.472-13.796; p = 0.276). No significant association between arachnoid opening procedures and functional recovery (assessed by modified Rankin Scale scores) was found during the 6- to 12-month follow-up period (p = 0.831).</p><p><strong>Conclusions: </strong>In adults with MMD, arachnoid membrane opening during combined bypass surgery did not significantly improve postoperative angiogenesis rates or increase perioperative complications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274836","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":"Three-dimensional microsurgical anatomy of the basal aspect of the cerebrum: a fiber dissection study.","authors":"Chen Li, Guangfu Di, Zhang Xiong, Lean Sun, Qiang Li, Haibo Li, Xiaochun Jiang, Jinsong Wu","doi":"10.3171/2025.5.JNS242560","DOIUrl":"https://doi.org/10.3171/2025.5.JNS242560","url":null,"abstract":"<p><strong>Objective: </strong>Due to the unique nature of the basal structures of the cerebrum, only a limited portion is exposed during surgery, leading to potential risk of damage to surrounding structures. The white matter fiber tracts in the basal cerebrum may be more critical than the cortex in determining the extent of resection. A thorough understanding of the 3D anatomy of these fiber tracts is essential for planning safe and precise surgical approaches and provides an anatomical foundation for studying brain function. This study aimed to examine the topographical anatomy of the fiber tracts and subcortical gray matter in the basal cerebrum, as well as their anatomical relationships with the cerebral cortex, ventricles, and associated nuclei.</p><p><strong>Methods: </strong>Using fiber dissection techniques and magnification ranging from ×6 to ×40, the authors studied 10 formalin-fixed human brains. The study focused on the fiber tracts and subcortical nuclei in the basal cerebrum, including the hippocampus, amygdala, and nucleus accumbens, and their relationships were documented through 3D photography.</p><p><strong>Results: </strong>The topographical relationships between the commissural, projection, and association fibers and the significant nuclei in the basal cerebrum were identified. Notable landmarks related to the fiber tracts include the cortical gyri and sulci, major basal nuclei, and lateral ventricles. The fiber tracts also exhibited consistent interrelationships.</p><p><strong>Conclusions: </strong>The 3D microsurgical anatomy of the basal cerebrum provides valuable insights for planning precise and safe surgical approaches and offers anatomical evidence for further studies on brain function.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274870","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":"Assessment of auditory pathway microstructure in vestibular schwannoma patients: a quantitative diffusion tensor tractography study.","authors":"Aisha Halawani, Sarasa Tohyama, Pascale Tsai, Rana Barake, Fatemeh Hassannia, Mark Bernstein, Suneil Kalia, Gelareh Zadeh, Michael D Cusimano, Michael Schwartz, David Mikulis, Normand Laperriere, John Rutka, Mojgan Hodaie","doi":"10.3171/2025.6.JNS241972","DOIUrl":"https://doi.org/10.3171/2025.6.JNS241972","url":null,"abstract":"<p><strong>Objective: </strong>Vestibular schwannomas (VSs) are cerebellopontine angle tumors that can result in cranial nerve dysfunction, most commonly sensorineural hearing loss. Conventional structural MRI is unable to provide correlative information on cranial nerve function. In this study, the authors used multitensor tractography to study the white matter microstructural properties of the auditory neural pathway as a correlate of cranial nerve function in a cohort of VS patients. They evaluated the relationship between the auditory neural pathway microstructural properties using pure-tone audiometry (PTA) and the speech discrimination score (SDS).</p><p><strong>Methods: </strong>Retrospective chart review of 258 patients with VS treated at the Toronto Western Hospital Gamma Knife Radiosurgery Unit was conducted. Of these, 3T MR images were analyzed for 57 surgically naive patients with unilateral VS who had preoperative diffusion tensor imaging (DTI) and PTA and SDS results. Patients were excluded if they had bilateral tumors, previous surgical treatment (Gamma Knife radiosurgery or resection), or did not undergo DTI. DTI-derived metrics (fractional anisotropy [FA], radial diffusivity [RD], axial diffusivity [AD], and mean diffusivity [MD]) of five regions of interest positioned along the auditory neural pathway (ipsilateral superior olivary nucleus [SON] and trapezoid body [TB] and contralateral inferior colliculus, lateral lemniscus [LL], and medial geniculate body [MGB]) were measured bilaterally in all subjects. The diffusion metrics were correlated with quantitative average high-frequency (4000 and 8000 Hz) PTA and SDS results.</p><p><strong>Results: </strong>Salient areas of neuroanatomical correlation included the LL and SON (affected side), where a statistically significant diffusion metric change was seen. This was characterized by higher FA and lower RD values (LL and SON) and a higher AD value (SON). SDS positively correlated with the TB AD. PTA showed a significant negative relationship with MD at the LL and a positive relationship with AD at the inferior colliculus (affected side). PTA also showed a significant negative relationship with RD and MD at the SON and TB, and a positive relationship with FA and AD at the MGB on the contralateral side (all p < 0.05).</p><p><strong>Conclusions: </strong>This work outlines that quantitative DTI is a useful tool to evaluate the white matter microstructural alterations in the auditory neural pathway. Importantly, as a noninvasive tool, diffusion metrics can help in understanding the pathophysiology of hearing impairment in this group of patients.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274886","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":"Focused ultrasound capsulotomy: predicting the probability of successful lesioning based on skull morphology.","authors":"Emmanuel De Schlichting, Yuexi Huang, Ryan M Jones, Ying Meng, Xingshan Cao, Anusha Baskaran, Kullervo Hynynen, Clement Hamani, Nir Lipsman, Maged Goubran, Benjamin Davidson","doi":"10.3171/2025.6.JNS2588","DOIUrl":"https://doi.org/10.3171/2025.6.JNS2588","url":null,"abstract":"<p><strong>Objective: </strong>MR-guided focused ultrasound anterior capsulotomy (MRgFUS-AC) is an incisionless ablative procedure, which has shown reassuring safety and compelling efficacy in the treatment of refractory obsessive-compulsive disorder and major depressive disorder. However, in some patients lesions cannot be reliably generated due to patient-specific skull morphologies and properties. Despite screening patients for MRgFUS-AC using skull density ratio (SDR), up to 25% of cases experience treatment failure. This variability in technical success limits the real-world applicability of an otherwise highly impactful treatment, and a better predictor of success is needed.</p><p><strong>Methods: </strong>This study analyzed data from 60 attempted MRgFUS-AC treatments in 57 patients between 2017 and 2024. Treatments were categorized as success or failure based on lesion volume. Preoperative parameters, including SDR, skull thickness, angle of incidence, CSF volume, brain and head volumes, and lesion side, were recorded. Logistic and machine learning models were evaluated to construct a preoperative model to predict the probability of technical success.</p><p><strong>Results: </strong>A total of 157 lesions were treated, of which 31 experienced treatment failure. Higher SDR, thinner skulls, and lower incident angles were significantly associated with successful outcomes (all p < 0.05). The logistic regression model performed the best among the models tested, with an accuracy of 0.81 ± 0.07 and an F1 score of 0.89 ± 0.04. The model was incorporated into a predictive tool to aid in identifying candidates for MRgFUS-AC.</p><p><strong>Conclusions: </strong>SDR, skull thickness, and angle of incidence significantly influenced the likelihood of successful MRgFUS-AC lesioning. Incorporating these three parameters into a predictive tool can dramatically reduce technical failure rates and may be especially informative in patients with an SDR between 0.35 and 0.55.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274815","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. Immunogenic amplification of focused ultrasound therapy.","authors":"Matteo Palermo, Carmelo Lucio Sturiale","doi":"10.3171/2025.6.JNS251613","DOIUrl":"https://doi.org/10.3171/2025.6.JNS251613","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274850","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":"Common peroneal nerve schwannomas around the knee: a surgical case series of 44 patients and systematic review of the literature.","authors":"Godard C W de Ruiter, Kirsten M Hayford, Thomas F H Vissers, Robert J Spinner","doi":"10.3171/2025.5.JNS25705","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25705","url":null,"abstract":"<p><strong>Objective: </strong>Resection of common peroneal nerve (CPN) schwannomas is generally believed to be associated with a high risk of postoperative deficit, especially the chance for development of a foot drop. The goal of this study was to investigate the surgical results for resection of schwannomas from the CPN around the knee and specifically the chance of developing a postoperative motor deficit.</p><p><strong>Methods: </strong>Data from 36 patients with sporadic schwannomas and 8 patients with schwannomatosis (12 schwannomas total) treated at two centers were retrospectively analyzed. For sporadic cases, different locations around the knee were compared (i.e., proximal to the fibular head [FH], at the FH, and distal to the FH), taking into account the preoperative duration of symptoms, size at presentation, and surgical results of resection. The literature was systematically reviewed for reported cases by searching the PubMed and Embase databases.</p><p><strong>Results: </strong>A total of 24 schwannomas proximal to the FH were surgically treated: 11 at the FH, and 13 distal to the FH. For the entire cohort, the mean size of CPN schwannomas distal to the FH at presentation was smaller (1.4 × 1.8 cm) compared with those proximal to (2.0 × 2.2 cm) and at (2.2 × 2.3 cm) the FH, although these differences were not statistically significant. The mean preoperative duration of symptoms was slightly longer for schwannomas distal to the FH (35 months) than for those proximal to the FH (21 months) and at the FH (27 months); however, this difference was not significant. Postoperative deficits occurred in 3 sporadic cases: 2 patients with temporary weakness (Medical Research Council grade 4) that completely resolved within several months and 1 patient who had previously undergone surgery elsewhere and presented with deficits and in whom weakness increased after resection. Improvement in preoperative deficits was observed in 1 patient with extensor hallucis longus muscle paralysis that completely recovered. One patient with schwannomatosis developed muscle weakness after resection of a plexiform schwannoma. A systematic review of 21 previously reported cases in the literature showed that larger CPN schwannomas (> 5 cm) were more likely to result in permanent motor deficits.</p><p><strong>Conclusions: </strong>This retrospective study of 44 patients shows that peroneal nerve schwannomas around the knee can be safely removed with a low risk of deficits. The systematic review of the literature suggests that larger schwannomas are more likely to result in permanent deficit. In the authors' opinion, CPN schwannomas can best be resected, preferably when the lesion is relatively small.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225501","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":"Impact of GLP-1 receptor agonists on stroke, subarachnoid hemorrhage, and intracerebral hemorrhage: a propensity-matched multi-institutional cohort study.","authors":"Matias Costa, Sean O'Leary, Anthony M Price, Christopher C Young, Visish M Srinivasan, Peter Kan","doi":"10.3171/2025.5.JNS25786","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25786","url":null,"abstract":"<p><strong>Objective: </strong>The authors evaluated whether glucagon-like peptide-1 receptor agonists (GLP-1-RAs) improve outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH), spontaneous intracerebral hemorrhage (sICH), and acute ischemic stroke (AIS) and reduce the overall incidence of these events.</p><p><strong>Methods: </strong>This retrospective study leveraged TriNetX data (2014-2024) to identify patients with aSAH, sICH, or AIS. Individuals receiving exenatide, lixisenatide, semaglutide, dulaglutide, liraglutide, or tirzepatide within 8 weeks of diagnosis were propensity matched to controls. Outcomes (e.g., mortality, rebleeding/recurrence, seizures, hydrocephalus) were assessed at 6 and 12 months; the incidence rates of stroke types were examined at 1 and 2 years.</p><p><strong>Results: </strong>For aSAH patients, GLP-1-RA use at 6 months reduced rebleeding (OR 0.73, p = 0.003) and mortality (OR 0.41, p < 0.001) and at 1 year lowered cognitive deficits (OR 0.63, p = 0.034) and mortality (OR 0.39, p < 0.001). In sICH patients, GLP-1-RAs decreased hydrocephalus (OR 0.37, p = 0.005) and seizures (OR 0.56, p = 0.007) at 6 months, with persistent benefits at 1 year (hydrocephalus, OR 0.38, p = 0.007; seizures, OR 0.63, p = 0.018), alongside lower mortality (OR 0.45-0.40, both p < 0.001) and rebleeding (OR 0.70-0.69, both p < 0.001) rates. In AIS patients, mortality fell at 6 months (OR 0.27, p < 0.001) and 1 year (OR 0.44, p < 0.001), with reduced recurrence (OR 0.60, p < 0.001) and lower hydrocephalus (OR 0.32, p < 0.001) and seizure (OR 0.43, p < 0.001) rates at 6 months. At 1 year, GLP-1-RA users had lower incidence rates of SAH (OR 0.64, p = 0.001), ICH (OR 0.62, p < 0.001), and AIS (OR 0.82, p = 0.003), which were sustained at 2 years (ORs 0.77-0.87, all p < 0.05). Adverse events were similar.</p><p><strong>Conclusions: </strong>GLP-1-RAs were associated with improved survival and fewer complications across stroke subtypes, plus reduced hemorrhagic and ischemic stroke incidence. Prospective trials are warranted to confirm these observations.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225616","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}