Journal of neurosurgery最新文献

{"title":"Diagnostic performance of bedside transcranial ultrasound after decompressive craniectomy: a comparative study with cranial computed tomography.","authors":"Artur Kwiatkowski, Claudia Sbriglio, Adam Druszcz, Daniel Gheek, Klaudia Jatczak, Mariusz Ptak","doi":"10.3171/2026.4.JNS26111","DOIUrl":"https://doi.org/10.3171/2026.4.JNS26111","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the diagnostic effectiveness and accuracy of bedside transcranial ultrasonography performed through the craniectomy in diagnosing typical post-decompressive craniectomy (DC) complications, using cranial CT as the reference standard.</p><p><strong>Methods: </strong>This retrospective study analyzed 88 consecutive patients who underwent DC between January 2023 and December 2024. In each case, bedside transcraniectomy ultrasonography (BTUS) was performed prior to CT imaging, and findings from both modalities were compared. Diagnostic agreement was evaluated using Cohen's kappa coefficient. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated for BTUS in identifying complications, including hematomas, hygroma, hydrocephalus, abscess, edema, and midline shift.</p><p><strong>Results: </strong>BTUS has high diagnostic accuracy compared with CT, with overall sensitivities ranging from 59.4% (edema) to 100% (hematomas) and specificities between 94.2% and 100%. Strong or almost perfect agreement (κ > 0.8) was observed for most complications. The rate of false negatives was lowest for space-occupying lesions and highest for diffuse pathologies, such as edema. Negative predictive values remained above 80% for all major complication types.</p><p><strong>Conclusions: </strong>BTUS provides a rapid, noninvasive, and readily available tool for the initial detection and monitoring of postcraniectomy complications. While it does not entirely replace CT in complex cases, it holds significant potential as a first-line screening and monitoring modality in neurosurgical intensive care settings. Bedside ultrasonography can significantly reduce reliance on CT scans, particularly in unstable or radiation-sensitive patients. Incorporating routine BTUS into post-DC monitoring protocols could enhance patient safety, expedite diagnosis, and optimize resource utlization in neurocritical care.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110944","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 prediction model for aneurysmal events to guide imaging surveillance in autosomal dominant polycystic kidney disease.","authors":"Satoshi Miyamoto, Shuhei Egashira, Yuta Otomo, Daiichiro Ishigami, Akinari Sekine, Naoki Sawa, Tatsuya Suwabe, Yoshifumi Ubara, Takehiko Wada, Wataro Tsuruta","doi":"10.3171/2026.4.JNS252347","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252347","url":null,"abstract":"<p><strong>Objective: </strong>Patients with autosomal dominant polycystic kidney disease (ADPKD) face a higher prevalence of intracranial aneurysms. However, the risk factors for aneurysmal events-particularly subarachnoid hemorrhage (SAH) or aneurysm growth, morphological changes, or de novo formation-remain poorly understood, leading to a lack of standardized policy of follow-up. This study aimed to identify predictors of such high-risk events and develop a risk prediction model to guide follow-up strategies.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at 2 ADPKD referral centers in Japan. A total of 1267 adult patients with ADPKD who underwent brain imaging between 2003 and 2024 at 2 Japanese referral centers were eligible, and 132 patients with untreated intracranial aneurysms and follow-up imaging were finally included. The primary outcome was the composite of aneurysm growth, morphological change, de novo formation, or rupture. A multivariable logistic regression analysis was used to pick up variants for prediction model. Internal validation was performed in a validation cohort of 638 patients and also via bootstrapping (n = 2000).</p><p><strong>Results: </strong>Multiple aneurysms (OR 5.56, p < 0.001), hypertension (OR 3.60, p = 0.063), and family history of ADPKD (OR 2.24, p = 0.131) were chosen as the scoring variables, resulting in the 4-point scoring model. This model demonstrated good prediction both in derivation and validation cohort discrimination (apparent AUC = 0.724; optimism-corrected AUC = 0.726). The Kaplan-Meier curves divided by the risk groups showed clear stratification, and the 5-year incidence of the composite outcome were 0% (low risk), 12% (moderate risk), and 46% (high risk) in the validation cohort.</p><p><strong>Conclusions: </strong>The authors developed an internally validated, easily applicable risk score for predicting aneurysm-related events in ADPKD patients. Generalization requires caution because of potential selection bias, and external validation is warranted.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111004","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":"Angiographic classification of nonacute carotid artery occlusion to predict the feasibility and clinical outcomes of endovascular recanalization.","authors":"Chao Hou, Huajuan Hou, Xuan Shi, Shuxian Huo, Qin Yin, Xianjun Huang, Wen Sun, Guodong Xiao, Yong Yang, Hongbing Chen, Min Li, Mingyang Du, Yunfei Han, Xiaobing Fan, Xinfeng Liu, Gelin Xu, Ruidong Ye","doi":"10.3171/2026.4.JNS251437","DOIUrl":"https://doi.org/10.3171/2026.4.JNS251437","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular treatment of nonacute symptomatic carotid artery occlusion (NASCAO) remains a technical challenge. The heterogeneity of a successful recanalization rate has limited its clinical efficacy. The aim of this study was to introduce an angiographic classification to determine the feasibility and clinical outcomes of endovascular recanalization for NASCAO patients.</p><p><strong>Methods: </strong>The authors analyzed consecutive patients who underwent endovascular treatment of NASCAO in a nationwide prospective registry. Patients were divided into 4 occlusion groups according to a novel classification based on distal carotid reconstitution level, distal retrograde stump morphology, and proximal stump morphology. The rate of technical success, procedural complications, 30-day postoperative stroke risk, and long-term clinical outcomes were analyzed.</p><p><strong>Results: </strong>Of 425 patients enrolled in the final analysis, the overall successful recanalization rate was 55.8% (237/425), and the 30-day postoperative major stroke rate was 3.8% (16/425). The rate of technical success was 80.7% (92/114) for type A, 80.7% (88/109) for type B, 40.9% (47/115) for type C, and 11.5% (10/87) for type D occlusions (p < 0.001). No differences were found for intraoperative complications and 30-day strokes among the 4 types. During a median follow-up of 37 months, patients with type A and B carotid occlusions had significant lower ischemic cerebrovascular event risk than patients with type C and D occlusions (type A and B vs type C and D: adjusted HR 0.274, 95% CI 0.144-0.520; p < 0.001).</p><p><strong>Conclusions: </strong>In NASCAO patients with recanalization attempts, type A/B occlusion was associated with a higher success rate and a lower long-term risk of ischemic cerebrovascular event. The NASCAO classification may assist in the selection of appropriate patients for endovascular treatment.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110652","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":"Publisher's Note. Partnering with Oxford University Press: a new chapter for JNSPG.","authors":"Gillian Shasby, Fred G Barker","doi":"10.3171/2026.9.JNS268000","DOIUrl":"https://doi.org/10.3171/2026.9.JNS268000","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110955","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":"Cryoprobe to current practice: neurosurgical legacies of Dr. Irving S. Cooper in movement disorders.","authors":"Kelly Fisher, Kate Tsirelman, Sahdev Singh Baweja, Aarti Kishore Jain, Robert Fekete","doi":"10.3171/2026.4.JNS26203","DOIUrl":"https://doi.org/10.3171/2026.4.JNS26203","url":null,"abstract":"<p><p>Before the advent of levodopa therapy for Parkinson's disease, surgical lesioning of the motor thalamus or globus pallidus represented the primary therapeutic intervention for Parkinson's disease and essential tremor at a time when effective medical alternatives were severely limited. In this context, Irving S. Cooper directed one of the most prolific and controversial lesioning practices of the mid-20th century, performing thousands of procedures and documenting outcomes. Through chemopallidectomy, chemothalamectomy, and later cryosurgical techniques, Cooper investigated the relationship between basal ganglia targets and motor symptoms, establishing reproducible symptom-anatomy associations for tremor and rigidity. Cooper's work introduced a systematic approach to target selection that contrasted with earlier lesioning methods. His outcomes demonstrated alleviation of tremor and rigidity when lesions were accurately placed, while highlighting risks of bilateral procedures. Most notably, the cryogenic \"test-freeze\" method allowed reversible intraoperative physiological inhibition, enabling assessment of clinical benefit before permanent lesions. Although many techniques were later abandoned, principles derived from Cooper's work continue to shape contemporary practice. Modern neuromodulation strategies, including deep brain stimulation and MR-guided focused ultrasound, rely on symptom-based targeting paradigms established during the lesioning era. This vignette examines how Cooper's innovations informed modern targeting strategies and standards of safety in functional neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110720","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":"Use of structure-function coupling to assess compensatory motor cortex flexibility and predict postoperative motor outcomes in patients with motor area gliomas.","authors":"Xijie Wang, Tao Yu, Xiaokang Zhang, Xuzhe Zhao, Mingxiao Li, Haoyi Li, Zhentao Zuo, Yong Cui, Xiaohui Ren, Song Lin, Dabiao Zhou","doi":"10.3171/2026.4.JNS26181","DOIUrl":"https://doi.org/10.3171/2026.4.JNS26181","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to investigate the mechanisms of motor compensation in glioma patients by quantifying both the structural decoupling index (SDI) value and the integrity of transcallosal white matter tracts. The authors aimed to evaluate their individual and combined utility in predicting long-term postoperative motor outcomes.</p><p><strong>Methods: </strong>Seventy patients with motor area gliomas and 23 healthy controls were retrospectively included. All participants underwent preoperative 3T resting-state fMRI and diffusion MRI. The SDI value was computed using a graph signal processing approach to quantify the decoupling between functional activity and structural connectivity. White matter integrity and disconnection severity of the corpus callosum were assessed using TractSeg and tractography. Motor function was evaluated using the Medical Research Council scale preoperatively and at the 3-month follow-up. Statistical analyses included group comparisons, correlation analyses, and multivariate logistic regression to identify predictors of severe motor impairment (SMI).</p><p><strong>Results: </strong>Glioma patients exhibited altered SDI values in motor-related regions, including the precentral gyrus and thalamus. A higher SDI value in the contralateral precentral gyrus was associated with better motor recovery (p = 0.00025), while greater disconnection severity in the anterior midbody of the corpus callosum (CC4) correlated with poorer motor function (p = 0.00041). Multivariate analysis identified IDH-wildtype status, higher CC4 disconnection severity, and lower contralateral precentral gyrus SDI value as independent predictors of SMI. A nomogram integrating these factors showed excellent predictive accuracy (C-index = 0.914).</p><p><strong>Conclusions: </strong>The SDI captures adaptive functional decoupling in the contralateral motor cortex, which may be associated with compensatory mechanisms in glioma patients. Combined with callosal integrity, the SDI enhances the prediction of postoperative motor outcomes, offering a novel biomarker for preoperative risk stratification and personalized rehabilitation planning.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110917","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":"Brain tumor surgery outcomes in rural America: a cross-sectional statewide study.","authors":"Sophie Epstein, Zerubabbel K Asfaw, Tirone Young, John Durbin, Lewis E Tomalin, Isabelle M Germano","doi":"10.3171/2026.4.JNS252166","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252166","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate demographic characteristics and predictors of adverse outcomes among rural New York State (NYS) residents undergoing neurosurgical treatment for brain tumor (BT), with the goal of identifying factors contributing to increased healthcare costs and diminished quality of care.</p><p><strong>Methods: </strong>This retrospective cross-sectional study analyzed 2010-2020 discharge data from the New York Statewide Planning and Research Cooperative System (SPARCS). Adults (≥ 18 years) who underwent neurosurgical treatment for BT in NYS hospitals were included, excluding patients residing in New York City. Rural residence was defined by US Department of Justice criteria. Sociodemographic variables included age, race/ethnicity, income quartile, and insurance status. Primary outcomes were postoperative length of stay (LOS), location of discharge (home vs nonhome), emergency department (ED) presentation, and 30-day mortality. Univariate and multivariate mixed-effects regression models identified independent predictors of adverse outcomes.</p><p><strong>Results: </strong>Among 25,887 patients, 3745 (14%) resided in rural areas. Despite a significant decline in the NYS rural population during the study period (p < 0.001), rural BT neurosurgical admissions increased (p = 0.005). Rural patients were more often White (91% vs 80%, p = 0.0425) and from lower income quartiles (66% vs 39%, p = 0.0015) than nonrural patients. On multivariable analysis, age > 65 years, male gender, and non-White race predicted ED presentation, whereas private insurance was protective. Nonhome discharge and ED presentation were the strongest predictors of prolonged LOS. ED presentation and older age predicted a nonhome discharge, while private insurance favored home discharge. Thirty-day mortality was independently associated with nonhome discharge, male gender, lower income, and longer LOS. Rural residence was not independently associated with any outcome after adjustment.</p><p><strong>Conclusions: </strong>Rural NYS residents undergoing neurosurgical treatment for BT face increasing procedural demand despite a shrinking rural population. Targeted care coordination, improved access pathways, and telemedicine/artificial intelligence-supported interventions may reduce disparities, costs, and adverse outcomes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.8,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110738","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 and validation of a prediction model for neurological outcomes of brain arteriovenous malformations undergoing microsurgical resection: a nationwide retrospective cohort study.","authors":"Yukun Zhang, Zhipeng Li, Yu Chen, Heze Han, Chengzhuo Wang, Li Ma, Yang Zhao, Weitao Jin, Xun Ye, Youxiang Li, Shuo Wang, Xiaolin Chen, Changyu Lu, Yuanli Zhao","doi":"10.3171/2026.4.JNS252453","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252453","url":null,"abstract":"<p><strong>Objective: </strong>Accurate prediction of neurological outcomes after microsurgical resection of brain arteriovenous malformations (AVMs) remains challenging because existing grading systems have only modest discriminatory power. In this study, the authors aimed to develop and validate a novel prediction model for neurological outcomes after AVM microsurgery.</p><p><strong>Methods: </strong>This prognostic cohort study utilized data from the MATCH (Multimodality Treatment for Brain Arteriovenous Malformation in Mainland China) registry from August 2011 to December 2021. The authors developed a novel prediction model, the AVM neurological outcome scale (AVM-NOS), via multivariable logistic regression analysis in a derivation cohort including 1151 patients from Beijing Tiantan Hospital and validated in a multicenter external cohort of 75 patients. The primary outcome was unfavorable neurological outcome (modified Rankin Scale score > 2) at the final clinical follow-up. The authors evaluated the AVM-NOS against the Spetzler-Martin and Lawton-Young grading systems in terms of discrimination (area under the receiver operating characteristic curve [AUC]), calibration, and decision-curve analysis.</p><p><strong>Results: </strong>The AVM-NOS incorporated six independent predictors associated with unfavorable outcomes: age, AVM volume, eloquence reclassification, deep perforating artery supply, exclusively deep venous drainage, and venous aneurysm. The scale exhibited superior predictive performance, with an AUC of 0.77 (95% CI 0.71-0.83) in the derivation cohort and 0.86 (95% CI 0.77-0.96) in the validation cohort, compared to the Spetzler-Martin grading scale (0.67 [95% CI 0.61-0.73] in the derivation cohort and 0.67 [95% CI 0.50-0.84] in the validation cohort) and Lawton-Young grading scale (0.72 [95% CI 0.67-0.78] in the derivation cohort and 0.75 [95% CI 0.58-0.92] in the validation cohort). Comprehensive model validation through calibration curves and decision curve analyses further confirmed the robust predictive performance and clinical applicability of the AVM-NOS.</p><p><strong>Conclusions: </strong>By integrating a refined eloquence classification, quantitative lesion volume, and key vascular features, the AVM-NOS surpasses existing models in predicting postoperative neurological outcome.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061912","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. Toward risk-stratified decision-making in cranioplasty after decompressive craniectomy.","authors":"Fang Wang, Kuilin Tian","doi":"10.3171/2026.4.JNS26760","DOIUrl":"https://doi.org/10.3171/2026.4.JNS26760","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061875","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":"Effectiveness of endoscopic third ventriculostomy in improving cognition and gait in adults with chronic obstructive hydrocephalus: a cohort study.","authors":"Catherine Veilleux, Gregory Larkin, Brij S Karmur, Sarah Edwards, Lauren Schulz, Joseph N Paulson, Albert M Isaacs, Mark G Hamilton","doi":"10.3171/2026.4.JNS252871","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252871","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic third ventriculostomy (ETV) is increasingly becoming the preferred treatment for adult chronic obstructive hydrocephalus (COH). However, there is limited evidence on how ETV affects cognitive and gait outcomes, both in the short and long term, in this population. This study was conducted to evaluate the effects of ETV on cognitive functions and gait in adults with COH.</p><p><strong>Methods: </strong>The authors retrospectively reviewed patients from their center who underwent ETV as the primary treatment for COH. Cognitive testing using the Montreal Cognitive Assessment (MoCA) and Symbol Digit Modalities Test was conducted before ETV and at 3 months and 1 year postoperatively. Gait velocity was measured using a 10-m walk test before ETV, and again at 3 months and 1 year post-ETV.</p><p><strong>Results: </strong>Ninety patients were included in our analysis. The average patient age was 55.4 (SD 13.5) years, and 47.8% (n = 43) of patients were female. Baseline MoCA scores averaged 23.1 (SD 3.1), improving to 25.7 (SD 2.6) at 3 months and 25.8 (SD 3.3) at 1 year (p < 0.001). The increase in MoCA score of 2.7 points met the minimal clinically important difference. Half of the patients had normal MoCA scores after ETV. Gait velocity significantly increased at 3 months and 1 year after ETV (p < 0.001), with mean gait velocity rising from 1.17 (SD 0.49) m/sec to 1.42 (SD 0.43) m/sec at 1 year. The 0.25 m/sec increase in gait velocity was clinically meaningful. With a few exceptions, the literature review found that most studies reported small patient groups, varied diagnoses, and inconsistent or missing reporting metrics.</p><p><strong>Conclusions: </strong>Cognition and gait improved at 3 months and were sustained 12 months after ETV in adult patients with COH. These findings provide additional evidence that ETV is an effective surgical choice for this patient group. The authors recommend using standardized, objective methods to evaluate etiology-specific ETV outcomes in adults.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061934","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}