Journal of neurosurgery最新文献

{"title":"Association between choroid plexus susceptibility features and motor outcomes following deep brain stimulation in Parkinson's disease.","authors":"Siyuan Fang, Chunhui Yang, Ying Tang, Luguang Chen, Weiwei Zhao, Chao Ma, Gaiying Li, Xi Wu, Jianqi Li","doi":"10.3171/2026.4.JNS252510","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252510","url":null,"abstract":"<p><strong>Objective: </strong>Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective therapy for advanced Parkinson's disease (PD), but postoperative motor outcomes show substantial interindividual variability. Recent evidence suggests choroid plexus (ChP) dysfunction in PD pathophysiology. This study aimed to investigate the association between preoperative ChP MRI characteristics and postoperative motor outcomes following STN-DBS in PD patients.</p><p><strong>Methods: </strong>Forty-one PD patients who underwent bilateral STN-DBS were included for final analysis. Motor outcomes were assessed using the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III scores at baseline and 6 months after surgery. ChP dysfunction was evaluated by quantifying volume from T1-weighted imaging and extracting susceptibility histogram features from quantitative susceptibility mapping (QSM). Correlation and receiver operating characteristic (ROC) analyses were performed to evaluate the predictive value of ChP imaging metrics.</p><p><strong>Results: </strong>Preoperative total motor scores were positively associated with maximum ChP susceptibility (r = 0.410, p = 0.008), while tremor and rigidity subscores correlated with kurtosis (r = 0.395, p = 0.011) and the 90th percentile (r = 0.356, p = 0.023), respectively, of the ChP susceptibility values. Postoperative total motor improvement showed significant positive correlations with the 10th percentile (r = 0.406, p = 0.009), mean (r = 0.325, p = 0.038), minimum (r = 0.322, p = 0.040), and skewness (r = 0.344, p = 0.028) of ChP susceptibility histogram features. For specific motor symptoms, bradykinesia improvement was positively associated with the 10th percentile (r = 0.394, p = 0.011), minimum (r = 0.335, p = 0.033), and skewness (r = 0.319, p = 0.042) of the ChP susceptibility values. Gait stability improvement correlated positively with the 10th percentile (r = 0.376, p = 0.016), mean (r = 0.379, p = 0.015), and median (r = 0.349, p = 0.026) values of ChP susceptibility. Combining ChP susceptibility histogram features with clinical characteristics achieved an area under the curve of 0.85 for differentiating superior from moderate responders to STN-DBS in terms of total motor outcomes.</p><p><strong>Conclusions: </strong>This exploratory study suggests that ChP microvascular damage and iron dysregulation are linked to preoperative motor severity in PD, while ChP calcification is significantly associated with motor responsiveness to STN-DBS. Combining the susceptibility histogram features of ChP calcification with clinical characteristics may offer additional value for improving patient-specific prognostication.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001719","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 the absence of a designated healthcare proxy preadmission in adults 65 years or older with operative traumatic brain injury.","authors":"Daniel Sconzo, Naveen Arunachalam Sakthiyendran, Aryan Wadhwa, Teresia Perkins, Nnaemeka Nwoke, Kaasinath Balagurunath, Alejandro Enriquez-Marulanda, Emanuela Binello","doi":"10.3171/2026.4.JNS253016","DOIUrl":"https://doi.org/10.3171/2026.4.JNS253016","url":null,"abstract":"<p><strong>Objective: </strong>Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in older adults, often necessitating complex medical decisions during the acute care phase. Authors of this study examine the impact of the absence of an established healthcare proxy (HCP) on clinical outcomes, hospital course, and healthcare costs in older adults who underwent operative management of TBI.</p><p><strong>Methods: </strong>At a large, urban, level 1 trauma center, a retrospective cohort study was conducted in patients 65 years of age or older who underwent operative management for TBI in the period from 2015 to 2021. Patients were stratified by the presence or absence of an HCP preadmission. Univariate and multivariate logistic analyses were performed. Outcomes of interest included mortality, functional recovery, overall hospital length of stay (LOS), and ICU stay. The financial implications of prolonged ICU stays were estimated using published cost data.</p><p><strong>Results: </strong>Among the 74 patients eligible for study inclusion, 28.4% (n = 21) did not have a designated HCP preadmission. These patients were more likely to undergo craniectomy (38.1% vs 9.4%, p < 0.01), and they experienced longer median ICU stays (12.5 vs 6 days, p = 0.02) and overall hospital stays (15 vs 9 days, p < 0.01). Only 11.3% of patients with an HCP underwent tracheostomy placement compared to 42.9% of those without an HCP (p < 0.01). Furthermore, those without HCPs were more likely to undergo gastrostomy (42.9% vs 18.9%, p = 0.03) and had significantly higher in-hospital mortality (52.4% vs 22.6%, p = 0.01). At the last follow-up, they had worse functional outcomes, with fewer attaining a modified Rankin Scale score ≤ 3 (20.0% vs 65.9%, p < 0.01). Craniectomy (OR 6.99, 95% CI 1.14-42.69, p = 0.04) remained significant after multivariate analysis, controlling for overall LOS, cardiovascular disease, procedure type, tracheostomy placement, gastrostomy placement, and primary care physician in the medical record.</p><p><strong>Conclusions: </strong>The absence of a designated HCP in older adults with operative TBI is associated with significantly higher mortality, worse functional outcomes, and longer hospitalizations. These findings highlight the need for proactive advance care planning and routine HCP designation discussions for older adults. Routine HCP designation could reduce unnecessary invasive care, improve patient-centered outcomes, and lower healthcare expenditures in this vulnerable population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001755","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":"Tailored endoscopic endonasal transoculomotor triangle approach for pituitary neuroendocrine tumors invading the parapeduncular space through the oculomotor triangle.","authors":"Haibo Zhu, Zehao Xiao, Jianing Yang, Chunhui Liu, Jiwei Bai, Lei Cao, Peng Zhao, Zhenye Li, Sen Cheng, Songbai Gui, Yazhuo Zhang, Chuzhong Li","doi":"10.3171/2026.4.JNS252128","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252128","url":null,"abstract":"<p><strong>Objective: </strong>Pituitary neuroendocrine tumors (PitNETs) with parapeduncular space (PPS) invasion through the oculomotor triangle present significant surgical challenges. The endoscopic endonasal approach (EEA) has emerged as a well-established technique for treating PitNETs, but surgical strategies for tumors invading the PPS need further optimization. The aim of this study was to evaluate the safety and efficacy of a tailored EEA for the treatment of PitNETs invading the PPS.</p><p><strong>Methods: </strong>The authors conducted a retrospective analysis of 72 patients with Knosp grade III and IV PitNETs invading the PPS who underwent an extended EEA between June 2019 and February 2025. A novel MM ratio (the maximum diameter of PPS tumor divided by the maximum diameter of the oculomotor triangle tumor neck) and the width of tumor neck were introduced as references for surgical approach selection. All patients underwent surgery using either the transoculomotor triangle corridor (TOT) or transsupra-interclinoid ligament corridor (TSICL) approach. Clinical data, including growth characteristics, imaging characteristics, surgical strategies and prognosis, were summarized.</p><p><strong>Results: </strong>The median MM ratio was 1.3. The TSICL approach achieved a higher gross-total resection (GTR) rate compared with the TOT approach (92% vs 70.2%). However, the TSICL approach was associated with higher rates of immediate postoperative oculomotor nerve paralysis (84% vs 34%). Recovery rates of oculomotor function were similar between the two approaches (TSICL: 61.9% at 3.6 months; TOT: 75% at 3.2 months). There was no statistically significant difference in the prognosis of postoperative oculomotor nerve paralysis between the two approaches. The data also showed that a smaller MM ratio, soft tumor texture, and TSICL approach were associated with complete resection. Logistic regression analysis showed that the MM ratio and the width of the tumor neck at the oculomotor triangle can serve as reference for whether to adopt the TSICL approach.</p><p><strong>Conclusions: </strong>An extended EEA can effectively resect PitNETs invading into PPS through the oculomotor triangle. For tumors with a narrower tumor neck and larger MM ratio, the parapeduncular tumor component usually cannot descend into the cavernous sinus through the oculomotor triangle after removal of the cavernous sinus tumor component. Therefore, a TSICL approach can achieve higher GTR rates despite temporarily increased oculomotor nerve dysfunction.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001946","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":"Comparative performance of 4 image scoring systems for vasospasm prediction after aneurysmal subarachnoid hemorrhage: superiority of the modified Hijdra total score.","authors":"Hraq Sarkis, Abed Alrazzak Kerhani, Carolin Albrecht, Ann-Kathrin Joerger, Chiara Negwer, Dennis Hedderich, Arthur Wagner, Bernhard Meyer","doi":"10.3171/2026.3.JNS26201","DOIUrl":"https://doi.org/10.3171/2026.3.JNS26201","url":null,"abstract":"<p><strong>Objective: </strong>The Fisher scale remains the most widely used CT-based grading system for predicting vasospasm following aneurysmal subarachnoid hemorrhage (aSAH), despite its recognized limitations. Alternative scoring systems, including the modified Fisher scale and quantitative blood burden assessment methods (Hijdra sum score and modified Hijdra total score), lack systematic comparative validation. In this study, authors compared the predictive performance of 4 CT-based image scoring systems for vasospasm occurrence in patients with aSAH.</p><p><strong>Methods: </strong>This retrospective study included consecutive patients with aSAH who were admitted to a single institution between January 2020 and June 2025. Initial noncontrast CT scans were independently assessed by neurosurgeons and reviewed by neuroradiologists using the Fisher scale, modified Fisher scale, Hijdra sum score, and modified Hijdra total score. Vasospasm was classified into 3 categories (none, asymptomatic, and symptomatic) using daily transcranial Doppler ultrasonography monitoring (days 3-14), with CTA and CT perfusion imaging for patients with poor acoustic windows. Ordinal logistic regression was performed to quantify associations between imaging scores and vasospasm severity.</p><p><strong>Results: </strong>Among the 370 patients included in the study (mean age 59.9 ± 13.6 years, 65.7% female), 228 (61.6%) developed vasospasm (182 symptomatic, 46 asymptomatic). The modified Hijdra total score demonstrated the greatest area under the receiver operating characteristic curve (AUROC) for any vasospasm (0.802, 95% CI 0.751-0.849), followed by the Hijdra sum score (0.759, 95% CI 0.709-0.809), modified Fisher scale (0.663, 95% CI 0.618-0.710), and Fisher scale (0.597, 95% CI 0.551-0.643). At a cutoff of ≥ 28 points, the modified Hijdra total score demonstrated 84.6% sensitivity and 67.6% specificity. The modified Hijdra total score explained the greatest variance in vasospasm severity (Nagelkerke R2 = 0.239; OR 1.103 per point, 95% CI 1.083-1.127, p < 0.001). Fisher-based scales demonstrated ceiling effects, with 77% of patients classified as having grade 4 SAH. The modified Hijdra total score, which excludes ventricular compartments, outperformed the original Hijdra sum score (ΔAUROC = -0.043, p = 0.024).</p><p><strong>Conclusions: </strong>The modified Hijdra total score outperformed Fisher-based categorical scales in vasospasm prediction in this cohort. Quantitative cisternal blood assessment provided superior discrimination compared to categorical grading, with an optimal threshold of ≥ 28 points. The superior performance of the modified Hijdra total score, which excludes ventricular blood, suggests that cisternal blood burden is the primary driver of vasospasm risk. Prospective validation in independent cohorts is needed.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001714","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":"Re-evaluating sources of electrode deviation in deep brain stimulation: surgical technique versus patient-specific brain mechanics.","authors":"Bingjie Zhou, Robert Ziechmann, Siyu Chen, Katelyn Mann, Mary K Kramer, Matthew B Kroen, Mahdi Alizadeh, Feroze B Mohamed, Curtis L Johnson, Qianhong Wu, Chengyuan Wu","doi":"10.3171/2026.3.JNS252633","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252633","url":null,"abstract":"<p><strong>Objective: </strong>Accurate electrode placement is crucial for optimizing outcomes in deep brain stimulation (DBS). Although reported mean radial deviations are 1.5 mm, a substantial amount deviate more than 2 mm, necessitating revision. Studies to date have largely focused on improving surgical techniques to improve target accuracy, but the role of brain mechanics remains understudied. The aim of this study was to evaluate MR elastography (MRE)-derived patient-specific mechanical factors, as well as surgical technique factors, as contributors to electrode deviation in DBS.</p><p><strong>Methods: </strong>Seventeen patients undergoing DBS to treat Parkinson's disease or essential tremor underwent preoperative MRI and MR elastography (MRE). Electrodes were implanted using a robotic image-guided image-verified technique. Insertion and rotation of the radiofrequency probe was captured with intraoperative video. The final electrode location was evaluated on postoperative CT. Local deviations along the entire intracranial path of the electrode were measured and aligned with brain biomechanical properties extracted from coregistered MRE data. Statistical analysis included t-tests, correlation analysis, and multiple linear regression. Laterality, probe insertion speed, probe rotational speed, and MRE metrics (stiffness, damping ratio, and their gradients) were independent variables for modeling electrode deviation along the trajectory.</p><p><strong>Results: </strong>Thirty-three trajectories were collected and analyzed using a consistent multiple linear regression model framework. All trajectory models yielded significant results (model p < 0.05) with a mean R2 of 0.71. MRE metrics explained a mean 71.27% of local deviation variance across 22 well-fitted trajectories (R2 > 0.7), while 11.50% was attributed to insertion and rotational speed and 17.23% was not explained by included variables. Trajectories with unacceptable target deviations were associated with increased range of stiffness and variation in stiffness, lower stiffness and damping ratios (p < 0.0028), and greater duration of disease (p = 0.04).</p><p><strong>Conclusions: </strong>This study demonstrated that brain biomechanical properties as measured via MRE are dominant predictors of persistent electrode deviation in DBS surgery. The findings suggest the need for a personalized patient-specific biomechanics-informed approach to improve targeting precision and surgical outcomes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001910","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":"Carotid atherosclerotic disease in aneurysmal subarachnoid hemorrhage: an underrated risk for cerebral infarction.","authors":"Adrian Engel, Laurèl Rauschenbach, Jan Rodemerk, Li Song, Meltem Gümüs, Christoph Rieß, Alejandro N Santos, Marvin Darkwah Oppong, Yan Li, Yahya Ahmadipour, Oliver Gembruch, Philipp Dammann, Ulrich Sure, Ramazan Jabbarli","doi":"10.3171/2026.3.JNS252031","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252031","url":null,"abstract":"<p><strong>Objective: </strong>Carotid atherosclerotic disease (CAD), which commonly results in internal carotid artery (ICA) stenosis, is a risk factor for ischemic stroke due to cerebral hypoperfusion. The aim of this study was to analyze the predictive value of CAD for the occurrence of infarction and an unfavorable outcome after aneurysmal subarachnoid hemorrhage (aSAH).</p><p><strong>Methods: </strong>Consecutive patients with aSAH treated at a central European tertiary care center between December 2004 and June 2016 were analyzed retrospectively. To quantify CAD, the North American Symptomatic Carotid Endarterectomy Trial score was calculated based on CTA. The study endpoints were the occurrence of cerebral infarction, subgrouped according to timing (≤ 48 hours vs > 48 hours), location in the ICA territory and its subterritories, and occurrence of an unfavorable outcome (modified Rankin Scale score ≥ 4) at 6 months. Binary logistic regression was used to adjust for the following confounders: age, radiological and clinical hemorrhage severity, vasospasm in the ICA, smoking status, arterial hypertension, obesity, and acute hydrocephalus.</p><p><strong>Results: </strong>Of 799 consecutive patients treated for aSAH, 378 (256 female, mean age 55.82 years) had CTA available and were included in this analysis. CAD was shown to have independent predictive value for an unfavorable outcome (adjusted OR [aOR] 1.02, 95% CI 1.00-1.05; p = 0.031) and the occurrence of infarction in the ICA territory (aOR 1.04, 95% CI 1.02-1.06; p < 0.001). Regarding infarction timing, there was an independent association with delayed cerebral infarctions (aOR 1.03, 95% CI 1.01-1.05; p = 0.006) but not with early infarctions (aOR 1.01, 95% CI 0.99-1.03; p = 0.388).</p><p><strong>Conclusions: </strong>These findings highlight the negative impact of CAD on the risk of cerebral ischemia and a poor outcome after aSAH. Further studies are needed to confirm the relevance of CAD during the clinical course of aSAH and to identify potential treatment strategies.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001743","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":"Increased risk of early recurrence after gross-total resection in males with a WHO grade II meningioma: the impact of sex on recurrence and death in 5441 meningioma patients.","authors":"Anders Broechner, Lasse Rehné Jensen, Tareq A Juratli, Andrea Daniela Maier, Sverre H Torp, Helen A Shih, Ramin A Morshed, Jacob S Young, Stephen T Magill, Luca Bertero, Walter Stummer, Dorothee Cäcilia Spille, Benjamin Brokinkel, Soichi Oya, Satoru Miyawaki, Nobuhito Saito, Martin Proescholdt, Yasuhiro Kuroi, Konstantinos Gousias, Matthias Simon, Jennifer Moliterno, Ricardo Prat Acin, Stéphane Goutagny, Vikram C Prabhu, John T Tsiang, Johannes Wach, Erdem Güresir, Junkoh Yamamoto, Young Zoon Kim, Joo Ho Lee, Daniel W Kim, Matthew Koshy, Karthikeyan Perumal, Mustafa K Baskaya, Donald M Cannon, Dennis C Shrieve, Chang-Ok Suh, Jong Hee Chang, Maria Kamenova, Sven Straumann, Jehuda Soleman, Ilker Y Eyüpoglu, Tony Catalan, Austin Lui, Philip V Theodosopoulos, Michael W McDermott, Pedro Góes, Aria Jamshidi, Ricardo Komotar, Michael E Ivan, Evan Luther, Fang Wang, Luis Souhami, Marie-Christine Guiot, Tamás Csonka, Toshiki Endo, Olivia Claire Barrett, Randy L Jensen, Tejpal Gupta, Akash J Patel, Tiemo J Klisch, Jun Won Kim, Francesco Maiuri, Valeria Barresi, María Dolores Tabernero, Simon Skyrman, Ian Law, Bjarne Winther Kristensen, Tina Nørgaard Munch, Torstein R Meling, Kåre Fugleholm, Tiit Mathiesen, Christian Mirian","doi":"10.3171/2026.3.JNS252398","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252398","url":null,"abstract":"<p><strong>Objective: </strong>Sex is a recognized factor in meningioma development, but its effect on recurrence and survival remains insufficiently studied in large clinical cohorts. This study aimed to investigate sex-specific differences in recurrence and survival across WHO grade I-III meningiomas, focusing primarily on outcomes after gross-total resection (GTR). Secondary analyses investigated outcomes after subtotal resection.</p><p><strong>Methods: </strong>Patients with intracranial meningiomas (n = 5441) from the international Personalized Neurosurgery database were identified; all were diagnosed according to the 2007 or 2016 WHO classification criteria, surgically treated, and followed between 1989 and 2019. The primary cohort consisted of 4372 patients who underwent Simpson grade I-III resections. Cumulative recurrence and survival risk were estimated. Multivariable logistic regression was used to obtain adjusted odds ratios comparing males to females. Counterfactual risk modeling and post hoc analyses were performed to assess age effects and center-level robustness.</p><p><strong>Results: </strong>Among patients with WHO grade II meningiomas, males had a significantly higher recurrence risk than females after GTR. At 5 years, males had more than two times the risk of recurrence (OR 2.21, 95% CI 1.42-3.42), declining toward no sex difference at 10 years. Counterfactual modeling showed an 83% higher 5-year recurrence risk in males with WHO grade II meningiomas (ratio of population-averaged risks 1.83, 95% CI 1.28-2.37), whereas no sex difference was observed if the same patients were instead classified as having WHO grade I meningioma. Post hoc analyses indicated that sex differences peaked in individuals of premenopausal age and diminished thereafter. The higher recurrence risk for males with WHO grade II meningiomas remained robust in sensitivity analyses. No consistent sex-related differences were detected in recurrence risk in WHO grade I meningioma or in the risk of death for WHO grade I or II meningioma. Among 1069 patients with Simpson grade IV resections, sex differences in recurrence and survival were not statistically significant.</p><p><strong>Conclusions: </strong>In this observational cohort, males with WHO grade II meningiomas who received GTR had a higher risk of early recurrence than females, an effect that appeared to be age dependent. These results do not exclude the possibility of sex-related risk differences in more slowly growing WHO grade I meningiomas with follow-up beyond 10 years. The findings raise the possibility of biological contributions linked to sex hormones, and the impact of sex on these survival outcomes should be validated in molecularly annotated cohorts.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945129","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":"A network analysis of faculty training and hiring in US academic neurosurgery departments.","authors":"Kashif Qureshi, Trevan Klug, George Sun, Om Jahagirdar, Dillon Huddleston, Huy Tran, Rhea Thakkar, Sebastian Saenz, Rayyan Darji, Khaled Alok, Carlos R Goulart, Mihir Gupta","doi":"10.3171/2026.3.JNS252473","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252473","url":null,"abstract":"<p><strong>Objective: </strong>Assembling faculty complements with diverse clinical backgrounds is critical to advancing patient care and trainee education in academic medicine. Whereas institutional relationships in other fields can be evaluated via collaborative grants and publications, metrics are lacking to characterize clinical departments and institutional networks. The aim of this study was to characterize connectivity among academic neurosurgery departments using social network analysis of individual-level faculty training histories and institutional characteristics, and to develop novel metrics within the specialty landscape.</p><p><strong>Methods: </strong>The authors performed a quantitative network analysis of US academic neurosurgery departments by integrating geographical, research funding, leadership, ranking, and faculty training information. Three metrics were developed to characterize each institution: 1) influence on network connectivity, 2) representation of different training backgrounds among faculty as a measure of institutional diversity, and 3) alumni career mobility.</p><p><strong>Results: </strong>The network of 115 programs and 1910 faculty members comprised a small group of strongly linked institutions surrounded by a larger sparsely connected group (modularity = 0.2402, skewness coefficient = 1.371). Clustering and influence were associated with geographic proximity, private institutional status, external rankings and department size (p < 0.001 for each). Institutional diversity and influence were negatively correlated (τ = -0.287, p < 0.001), suggesting that influential programs might be the most siloed. Mobility was significantly correlated with program leadership but not with influence or institutional diversity, suggesting that structural factors might not limit alumni trajectories. Programs clustered into one of 3 archetypes with respect to their relative strengths in influence, institutional diversity, and/or mobility; no programs had high scores in all 3 areas.</p><p><strong>Conclusions: </strong>The network of academic neurosurgery programs is nonrandom and highly structured. Connectivity, institutional cross-pollination, and alumni mobility are limited and unevenly distributed. Characterizing academic programs using graph theoretical approaches has the potential to advance clinical practice, trainee education, transparency, and equity.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945139","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":"Handheld cochlear nerve action potential mapping for real-time functional navigation in vestibular schwannoma surgery.","authors":"Xiaoyu Li, Xu Gong, Penghao Liu, Hanyi Jiao, Gang Song, Jiantao Liang","doi":"10.3171/2026.3.JNS252763","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252763","url":null,"abstract":"<p><strong>Objective: </strong>Hearing preservation in vestibular schwannoma (VS) surgery remains challenging due to frequent cochlear nerve displacement and the limited reliability of brainstem auditory evoked potentials (BAEPs) once waveforms deteriorate. This study evaluated the feasibility and clinical utility of bipolar handheld cochlear nerve action potential (CNAP) mapping for intraoperative nerve identification and compared its prognostic performance with BAEP monitoring.</p><p><strong>Methods: </strong>In this retrospective single-center cohort, 193 patients with histologically confirmed VS underwent intraoperative auditory mapping between September 2021 and November 2024. Two color-coded bipolar handheld probes were used: one for facial nerve stimulation and the other for near-field CNAP recording along the presumed cochlear nerve course. CNAP responses were considered favorable if waveforms remained stable or decreased by < 50% in amplitude. Functional hearing preservation (American Academy of Otolaryngology-Head and Neck Surgery class A-C) served as the primary endpoint. Logistic regression and receiver operating characteristic (ROC) analyses evaluated predictive performance.</p><p><strong>Results: </strong>CNAP mapping identified the cochlear nerve in 83.4% of cases, significantly higher than intraoperative BAEP elicitation (46.1%; p < 0.001). Favorable CNAP responses were strongly associated with hearing preservation (91.4% vs 8.1%, p < 0.001; adjusted OR 37.0, 95% CI 9.28-217.8). The combined CNAP + BAEP model showed excellent discrimination (area under the ROC curve = 0.91) and good calibration (p = 0.24, Hosmer-Lemeshow test).</p><p><strong>Conclusions: </strong>CNAP mapping enabled real-time functional localization of the cochlear nerve and provided complementary intraoperative functional information. While postoperative hearing remains dependent on the structural integrity of the cochlear nerve, particularly in large tumors, CNAP mapping provides complementary functional information strongly associated with hearing preservation.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891920","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":"Understanding the role of neuroendoscopy for treatment of hydrocephalus in adults with intracranial mass lesions: a case series.","authors":"Ryan M Hess, D Ryan Ormond","doi":"10.3171/2026.3.JNS253002","DOIUrl":"https://doi.org/10.3171/2026.3.JNS253002","url":null,"abstract":"<p><strong>Objective: </strong>Hydrocephalus can result from mass lesions for several reasons. Due to limited numbers of adult patients with mass lesions in studies that examine outcomes of endoscopic third ventriculostomy, success in this population is unclear. Additionally, the role of other ventriculoscopic procedures in the management of associated hydrocephalus is unclear. In this retrospective case series, the authors investigated optimal management strategies for patients with mass lesions and hydrocephalus.</p><p><strong>Methods: </strong>A list of patients who underwent ventriculoscopic procedures or shunting procedures was compiled. Basic demographics, pathology, etiology of hydrocephalus, imaging, surgical procedures, complications, and long-term outcomes were obtained from the electronic medical record. Patients were subanalyzed in groups based on pathology, type of hydrocephalus, and initial management strategy.</p><p><strong>Results: </strong>A total of 98 patients were identified. The most common pathologies causing hydrocephalus were gliomas, (n = 33, 33.67%), metastatic lesions (n = 17, 17.35%), pineal region tumors (n = 13, 13.27%), and cystic lesions (n = 13, 13.27%). Colloid cysts were excluded. Obstructive hydrocephalus was the most common cause of hydrocephalus (n = 102, 81.60%). All patients who presented with communicating hydrocephalus were treated with shunting. The long-term success of endoscopic approaches was 83.33%. Patients with gliomas and CNS lymphoma were least likely to be shunt free after endoscopic management.</p><p><strong>Conclusions: </strong>The etiology of hydrocephalus in patients with mass lesions is heterogeneous. Shunting is effective in patients with communicating hydrocephalus. Endoscopic management is successful in patients with obstructive hydrocephalus if their tumors do not have a propensity for leptomeningeal disease, such as high-grade gliomas or CNS lymphoma.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892035","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}