Journal of neurosurgery最新文献

{"title":"Association of PIK3CA mutations with brainstem location in sporadic cerebral cavernous malformations.","authors":"Martin Planet, Yohan Ducos, Mélanie Eyries, Pauline Marijon, Franck Bielle, Lucas Rincon de la Rosa, Agusti Alentorn, Bertrand Mathon, Florence Coulet, Michel Kalamarides, Matthieu Peyre","doi":"10.3171/2025.5.JNS25596","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25596","url":null,"abstract":"<p><strong>Objective: </strong>Since 2021, there has been a revolution in the understanding of the mutational landscape of sporadic cerebral cavernous malformations (CCMs), with the key discovery of somatic mutations in the PIK3CA and MAP3K3 genes. These genetic alterations have provided new insights into the pathophysiology of CCMs and opened potential venues for personalized treatments. However, establishing robust clinicoradiological and molecular correlations is essential to guide targeted therapeutic approaches and optimize patient outcomes.</p><p><strong>Methods: </strong>This study included a cohort of 89 patients diagnosed with sporadic CCMs. The mutational status of each patient was determined using next-generation sequencing (NGS) targeting known mutations including the PIK3CA, MAP3K3, and CCM genes. NGS findings were confirmed by droplet digital polymerase chain reaction for PIK3CA and MAP3K3 mutations. Clinical and radiological data, including Zabramski classification data, were systematically recorded. Statistical analysis was performed to identify significant clinicoradiological and molecular correlations.</p><p><strong>Results: </strong>In the cohort, PIK3CA somatic mutations were identified in 43 patients (48%), while MAP3K3 somatic mutations were found in 29 (33%). Clinically, PIK3CA-mutated lesions were less frequently revealed by intracranial hypertension (9.3% vs 19.6%; adjusted OR 0.09, p = 0.006), while for MAP3K3-mutated lesions, seizure as a mode of onset was significantly more frequent (85.7% vs 51.7%, p = 0.002). Radiologically, midline lesions were significantly more frequent in the PIK3CA-mutated group (19.0% vs 2.2%, p = 0.01). Importantly, in univariate analysis, the presence of a brainstem lesion was a significant independent predictor of PIK3CA somatic mutation (14.3% vs 2.2%; unadjusted OR 7.33, p = 0.03).</p><p><strong>Conclusions: </strong>This study presents new findings linking genetic mutations with clinicoradiological features in sporadic CCMs. The significant association of PIK3CA somatic mutations with brainstem location highlights a potential avenue for personalized therapeutic strategies targeting this mutation, considering the significantly increased morbidity and surgical challenge associated with brainstem lesions. These findings reinforce the importance of integrating genetic data into clinical practice to improve patient outcomes and develop new therapies for CCMs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225484","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":"Trends and contributing factors in medicolegal cases involving cranial surgery in Canada.","authors":"Sean Barry, Katherine Tourigny, Tricia Barry, Patricia J Finestone, Richard Liu, Jacqueline H Fortier, Anna MacIntyre, Gary Garber","doi":"10.3171/2025.5.JNS242939","DOIUrl":"https://doi.org/10.3171/2025.5.JNS242939","url":null,"abstract":"<p><strong>Objective: </strong>Neurosurgery is a high-risk specialty with a low margin of error, and neurosurgeons have a higher medicolegal risk than practitioners in many other specialties. The aim of this study was to provide a current medicolegal landscape of cranial surgery in Canada.</p><p><strong>Methods: </strong>In this retrospective descriptive study, the authors evaluated 10 years (2012-2021) of cranial neurosurgical data on closed legal actions, medical regulatory authority (College) cases, and hospital complaints against neurosurgeons that had been submitted to the Canadian Medical Protective Association (CMPA). Only cranial cases, even those involving ventriculoperitoneal shunt (VPS) placement or catheter or wire insertion in the brain, were eligible for study inclusion. Excluded cases were those involving pediatric patients and angiography, radiation, ultrasound, or percutaneous procedures.</p><p><strong>Results: </strong>Seventy-six cranial cases were included in the study. Neurosurgeons had a significantly higher medicolegal risk compared to that of the overall CMPA surgeon membership. Civil legal actions accounted for more than half of all the cranial cases. Fifty-four percent of cases involved postoperative complications, and 21% involved VPS placement. Communication issues were commonly named factors leading to a medicolegal complaint throughout the data.</p><p><strong>Conclusions: </strong>This is the first report on the Canadian experience of medicolegal cranial surgery cases. These cases most commonly involved tumor excision, VPS insertion, and decompressive craniectomy. The VPS cases were unexpectedly common and should be further investigated. A breakdown in communication was a major theme in the medicolegal data repository.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225625","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":"Artificial intelligence-based deep learning model for evaluating procedural consistency in microvascular anastomosis.","authors":"Jiuxu Chen, Thomas J On, Yuan Xu, Jonathan A Tangsrivimol, Kivanc Yangi, Rokuya Tanikawa, Michael T Lawton, Marco Santello, Baoxin Li, Mark C Preul","doi":"10.3171/2025.6.JNS25128","DOIUrl":"https://doi.org/10.3171/2025.6.JNS25128","url":null,"abstract":"<p><strong>Objective: </strong>Assessing the consistency and precision of microanastomosis performance is crucial in neurosurgical training. Traditional methods rely on expert observation, which can be subjective and time-consuming. The aim of this study was to develop and validate a deep learning model using long short-term memory (LSTM) architecture for objective evaluation of microanastomosis performance by predicting and comparing suturing executions.</p><p><strong>Methods: </strong>An LSTM-based neural network was developed to model and predict hand movements during microvascular anastomosis simulation. Video data were collected from 2 expert neurosurgeons performing microanastomosis twice, 1 year apart (sessions 1 and 2). Surgeon 1 performed interrupted suturing, and surgeon 2 performed continuous suturing. Additionally, a trainee with minimal microsurgical experience performed the interrupted suturing procedure once. Model performance was quantitatively assessed by comparing predicted and actual suturing executions using Kullback-Leibler (KL) divergence. Economy and flow of motion were also analyzed.</p><p><strong>Results: </strong>The LSTM-based model accurately predicted suturing movements. Surgeon 1 demonstrated KL divergence values of 0.00063 (session 1) and 0.00061 (session 2), and surgeon 2 had values of 0.00082 (session 1) and 0.00016 (session 2). The trainee exhibited higher KL divergence (0.00196), reflecting less consistent performance. The economy of motion was assessed, showing mean Euclidean distances of 7.41 mm (session 1) and 5.85 mm (session 2) for surgeon 1, 10.53 mm (session 1) and 14.46 mm (session 2) for surgeon 2, and 10.50 mm for the trainee. The flow of motion analysis indicated median time intervals between sutures of 31.96 seconds (session 1) and 29.57 seconds (session 2) for surgeon 1, 21.53 seconds (session 1) and 21.50 seconds (session 2) for surgeon 2, and 101.23 seconds for the trainee.</p><p><strong>Conclusions: </strong>The LSTM-based model objectively assessed microanastomosis performance, capturing consistency and efficiency. Economy and flow of motion metrics were further validated. Future studies will extend the model's application to more surgeons and refine interpretation of the performance metrics.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The history of neurosurgery at Tufts Medical Center.","authors":"Jacob Kosarchuk, M Harrison Snyder, Shrey Patel, Rahul Rodrigues, Alper Dincer, Abraham Boskovitz, T Jayde Nail, Ron Riesenburger, Adel Malek, Julian Wu, Carl Heilman","doi":"10.3171/2025.5.JNS2591","DOIUrl":"https://doi.org/10.3171/2025.5.JNS2591","url":null,"abstract":"<p><p>Tufts Medical Center grew from the Boston Dispensary, which was initially founded in 1796 by public-spirited Bostonians including Samuel Adams and Paul Revere. The union with Floating Hospital for Children, Pratt Diagnostic Center, and Tufts College Medical School transformed the Dispensary into the New England Medical Center in 1929. Though neurosurgical procedures were performed as early as the 1920s, the division was not established until 1948, and the residency program received Accreditation Council for Graduate Medical Education accreditation in 1950. Tufts-New England Medical Center was formed in 1968 after a merger with the newly renamed Tufts University School of Medicine and was again renamed Tufts Medical Center in 2008. The department has been led by Drs. Bertram Selverstone, Bennet Stein, William Shucart, Carl Heilman, and Ron Riesenburger. The residency program has produced neurosurgeons who have gone on to shape the field.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175843","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":"Trends in research output among practicing US neurosurgeons over the last 40 years.","authors":"Sameer Sundrani, Clayton R Baker, Anthony E Bishay, Austin M Hilvert, Lola B Chambless","doi":"10.3171/2025.5.JNS25565","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25565","url":null,"abstract":"<p><strong>Objective: </strong>Research output among neurosurgery residency applicants has increased in recent years. The authors sought to quantify the publication quantity of board-certified US neurosurgeons and to determine how publication quantity has changed over time.</p><p><strong>Methods: </strong>Publication data were extracted from Scopus for all neurological surgeons listed as board certified since 1980 by the American Board of Neurological Surgery. Distributions were analyzed on a decade-to-decade as well as continuous basis. Pre-board certification quantity of publication (general and first/senior author) was analyzed using multivariable regression. Univariate regression of pre-board certification rates was used to predict post-board certification rates.</p><p><strong>Results: </strong>For each decade since 1980, neurosurgeons have published more before receiving board certification than the decade prior, both in total as well as first/senior author publications. Neurosurgeons have also been publishing earlier as well as with increased coauthor counts (p < 0.001). A more recent date of board certification remains a significant and independent predictor of publication count when corrected for time since first publication and average coauthor counts (p < 0.001). Finally, the pre-board certification publication rate is an independent and significant predictor for the post-board certification publication rate (p < 0.001).</p><p><strong>Conclusions: </strong>This study suggests that neurosurgeons have consistently published earlier in their careers and in increasingly higher quantities over time. This finding is in line with similar trends for neurosurgery applicants, showcasing increasing output across career stages, which has important impacts on the field.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175845","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":"Clinical validation of a rapid, markerless, headset-contained augmented reality stereotactic neuronavigation system.","authors":"Joshua Olexa, Chixiang Chen, Parth Rastogi, Charles Sansur, Maureen Rakovec, Jordan R Saadon, Jesse Stokum, Kevin T Kim, Steven K Yarmoska, Annie Trang, Tina Wang, Jacob Cherian, Mohammed Labib, Alex Ksendzovsky, Clifford T Solomon, Whitney Parker, Gary Schwartzbauer, Graeme F Woodworth","doi":"10.3171/2025.5.JNS243160","DOIUrl":"https://doi.org/10.3171/2025.5.JNS243160","url":null,"abstract":"<p><strong>Objective: </strong>Digital enhancement and visualization technologies, such as augmented reality (AR), are increasingly used in surgery. Rapid and accurate patient registration with minimal device confinements enables AR systems to increase efficiency, safety, and effectiveness, especially in urgent/emergency and/or bedside scenarios. The aim of this study was to quantitatively compare an AR headset-based neuronavigation system with a standard-of-care reference array-based neurosurgical stereotactic navigation system in a real-world setting.</p><p><strong>Methods: </strong>This clinical validation trial included adult patients undergoing cranial neurosurgery with stereotactic navigation at a single center from February 2024 to July 2024. Preoperative CT and MR images were acquired and used for construction of a 3D hologram model that included surface-based target fiducial markers for comparison. Preoperative images were stereotactically registered to the patient's head using standard techniques. The registration coordinates for the fiducial markers (control) and registration time were recorded. The AR system was then deployed to create a separate stereotactic registration to the same preoperative images. A second set of registration coordinates for the fiducial markers (experimental) were acquired using the AR system, and the time for this process was also recorded. The Wilcoxon signed-rank test was used to assess differences in registration time, and a linear mixed-effects model (LMM) was used to conduct equivalence testing of coordinates between the control and experimental data.</p><p><strong>Results: </strong>Twenty patients (mean age ± SD 50.05 ± 14.38 years) were included in the trial. The mean baseline validation error of the control system was 0.73 ± 0.29 mm (range 0-1.0 mm). Using the control system as ground truth, the mean registration accuracy of the AR system was 2.16 ± 0.12 mm. LMM equivalence testing, conducted with margins of 3 mm and 2.5 mm, demonstrated statistical equivalence between the ground truth and AR system coordinates (p < 0.001 and p < 0.003, respectively). The time required for patient model registration using the AR system was a mean of 45.98 ± 15.00 seconds, which was significantly shorter compared with the control system (228.86 ± 100.06 seconds, p < 0.001).</p><p><strong>Conclusions: </strong>The AR navigation system provided statistically similar registration accuracy and significantly faster patient model registration compared with the standard-of-care stereotactic neuronavigation system. AR navigation was accurate, fast, and had a minimal footprint, offering new opportunities to incorporate stereotaxis in low-resource, bedside, and urgent/emergency settings.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.6,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145175836","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":"Efficacy of combined clazosentan and cilostazol therapy for cerebral vasospasm after subarachnoid hemorrhage: a retrospective multicenter registry study.","authors":"Issei Takeuchi, Shinsuke Muraoka, Fumie Kinoshita, Takashi Izumi, Kazuki Ishii, Masahiro Nishihori, Shunsaku Goto, Ryuta Saito","doi":"10.3171/2025.5.JNS243007","DOIUrl":"https://doi.org/10.3171/2025.5.JNS243007","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is associated with a poor prognosis. Since 2022, clazosentan has become available for clinical use in Japan and has shown potential in improving clinical outcomes for patients with aSAH. However, whether clazosentan alone is sufficient to achieve optimal results or combination therapy is required remains unclear. In this study, the authors aimed to assess the efficacy of combining clazosentan and cilostazol for treating cerebral vasospasm following aSAH due to a ruptured cerebral aneurysm.</p><p><strong>Methods: </strong>This retrospective multicenter study was conducted using repository data from April 2023 to March 2024 from across 20 institutes. Patients who underwent coil embolization or surgical clipping within 48 hours of aSAH and had a preoperative modified Rankin Scale (mRS) score of 0-2 were eligible for inclusion in the study. Patients who received clazosentan plus fasudil were excluded. The patients were divided into two groups: those who received clazosentan plus cilostazol (cilostazol combination group) and those who did not receive cilostazol (noncilostazol group). Outcomes were measured based on discharge mRS scores (primary) and complications (secondary), including cerebral vasospasm, delayed cerebral ischemia (DCI), pulmonary complications, hypotension, cerebral edema, and de novo intracranial hemorrhage.</p><p><strong>Results: </strong>In total, 161 patients were included in this study, with 94 and 67 patients in the cilostazol combination and noncilostazol groups, respectively. No significant difference was observed between the two groups in terms of optimal outcomes at discharge (mRS score 0-2). However, the cilostazol combination group tended to experience a lower rate of poor outcomes than the noncilostazol group (11.7% vs 14.9%, respectively, OR 0.36, 95% CI 0.11-1.2, p = 0.095). The incidence rate of DCI was significantly lower in the cilostazol combination group than in the noncilostazol group (0.0% vs 7.5%, p = 0.02). No significant differences were found between the two groups with respect to other complications.</p><p><strong>Conclusions: </strong>The combination of clazosentan and cilostazol may reduce the incidence of DCI, although its impact on functional outcomes remains unclear. Further research is warranted to explore effective pharmacological strategies for improving the prognosis of aSAH.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091908","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":"Proof-of-concept study of noninvasive, rapid, machine learning-enhanced, color-based CSF diagnostics: a novel approach to external ventricular drain infection screening.","authors":"Bilal B Akbulut, Barış O Gürses, Semiha Özgül, Mustafa S Bölük, Taşkın Yurtseven, Hüseyin Biçeroğlu","doi":"10.3171/2025.5.JNS25628","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25628","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to develop and validate a proof-of-concept, low-cost, noninvasive device capable of continuously monitoring CSF in external ventricular drainage systems in order to enable earlier detection of infections.</p><p><strong>Methods: </strong>The authors designed BOSoMetre (CSF-o-Meter), a device that uses a microcontroller and TCS3200 color sensor housed in a 3D-printed chamber for continuous CSF monitoring. The system captures real-time optical measurements across red, green, blue, and clear channels through the external ventricular drain (EVD) tube. Between October 2024 and January 2025, the authors prospectively enrolled 20 patients requiring EVD placement for obstructive hydrocephalus or infection, with 15 included in the final analysis. CSF samples were classified according to Infectious Diseases Society of America 2017 guidelines. The authors processed approximately 4.8 million sensor readings and applied machine learning algorithms using two validation approaches: the subspace k-nearest neighbors (KNN) classifier with 80-20 split validation, and random forest with leave-one-patient-out cross-validation (LOOCV).</p><p><strong>Results: </strong>The subspace KNN classifier with 80-20 split validation yielded 90.4% accuracy with 92% sensitivity and 90.4% specificity (area under the curve [AUC] 0.968). The more stringent random forest with LOOCV approach achieved 81.1% accuracy with 71.5% sensitivity and 89.2% specificity (AUC 0.736). The device successfully distinguished between clean and infected CSF samples, with particularly high specificity in identifying noninfected samples.</p><p><strong>Conclusions: </strong>BOSoMetre shows promise as a low-cost (< €100), open-source tool for continuous CSF monitoring and early infection detection, especially for resource-limited settings. The high specificity could potentially reduce unnecessary CSF sampling and associated iatrogenic infection risks. Although the initial results are encouraging, further validation in larger cohorts is needed to confirm clinical utility and overcome the technical limitations identified in this proof-of-concept study.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091972","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. Concerning interposition versus transposition for MVD in trigeminal neuralgia.","authors":"Melanie Kristt, Guy M McKhann, Raymond F Sekula","doi":"10.3171/2025.6.JNS251497","DOIUrl":"https://doi.org/10.3171/2025.6.JNS251497","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091986","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":"Role of post-thrombectomy glymphatic flow in futile recanalization in large-vessel occlusion ischemic stroke.","authors":"Alan J Finkelstein, Matthew T Sipple, Sajal Medha K Akkipeddi, Racquel Whyte, Gurkirat Singh Kohli, Stephen Susa, Rohin Singh, Prasanth Romiyo, Jianhui Zhong, Tarun Bhalla, Thomas Mattingly, Vincent N Nguyen, Maiken Nedergaard, Matthew T Bender, Derrek Schartz","doi":"10.3171/2025.5.JNS25210","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25210","url":null,"abstract":"<p><strong>Objective: </strong>Stroke is a leading cause of global death and disability, with mechanical thrombectomy remaining the optimal treatment approach for large-vessel occlusion (LVO) ischemic stroke. Despite endovascular recanalization, nearly half of patients experience poor functional outcomes, a phenomenon termed \"futile recanalization.\" The cerebral glymphatic system has emerged as a potential, yet underexplored, therapeutic target. The aim of this study was to use glymphatic diffusion tensor analysis on post-thrombectomy MRI to evaluate the association between glymphatic flow, clinical outcomes, and futile recanalization in patients with LVO ischemic stroke.</p><p><strong>Methods: </strong>In this retrospective study, 133 patients with anterior LVO ischemic stroke and available post-thrombectomy MRI at a single center from 2017 to 2021 were identified. Futile recanalization was defined by a modified Rankin Scale score > 2 at 90 days despite achieving complete or near-complete angiographic recanalization (modified thrombolysis in cerebral infarction grades 2b-3). Diffusion tensor imaging along the perivascular space was used to evaluate glymphatic function in patients with futile recanalization and patients with functional independence at 90 days. Spearman's rank correlation was used to examine associations between the along the perivascular space index and clinical variables. Effect sizes were calculated and reported using Cohen's d.</p><p><strong>Results: </strong>Fifty-five patients (24 male, mean age 73.9 years) with anterior circulation LVO ischemic stroke and adequate post-thrombectomy MRI were included for analysis. Overall, glymphatic clearance was lower on the infarcted side compared with the contralateral side (p = 0.035). Patients with futile recanalization had lower glymphatic flow compared with those with functional independence at 90 days (p = 0.049). Additionally, glymphatic flow was significantly associated with the presenting National Institutes of Health Stroke Scale score (ρ = -0.46, p = 0.002).</p><p><strong>Conclusions: </strong>These findings suggest that patients with futile recanalization have comparatively worse glymphatic clearance. Further research is required to clarify the relationship between futile recanalization and the glymphatic system, which could facilitate the development of therapeutic adjuncts.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145092002","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}