Journal of neurosurgery最新文献

{"title":"Natural history of endogenous collateral vessels after revascularization surgery in patients with moyamoya angiopathy.","authors":"Robert Mertens, Kristin Lucia, Katharina Kersting, Maximilian Stahnke, David Wasilewski, Lukas Mödl, Erin Dirk Sprünken, Lucius Fekonja, Lars Wessels, Güliz Acker, Peter Vajkoczy","doi":"10.3171/2024.10.JNS241589","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241589","url":null,"abstract":"<p><strong>Objective: </strong>Moyamoya angiopathy (MMA) is characterized by the plasticity to develop endogenous collateral blood vessels to compensate for progressive steno-occlusion of proximal intracranial arteries. Bypass surgery has been anecdotally reported to induce regression of these collateral vessels, but a detailed analysis of their natural history is lacking. Here, the authors characterize these collaterals after bypass surgery.</p><p><strong>Methods: </strong>A single-center retrospective analysis of the medical records of 81 predominantly Caucasian MMA patients (121 hemispheres) treated with a combined superficial temporal artery-middle cerebral artery bypass and encephalodurosynangiosis between January 2011 and December 2021 was performed. Clinical data and longitudinal angiographic images were investigated to compare the development of different collateral types and to analyze the dependency between collateral vessels and bypass quality.</p><p><strong>Results: </strong>A total of 58 female and 23 male patients with a mean age of 41 ± 13.1 years at the time of first surgery were included. The majority of patients (92.6%) were European Caucasian. Ischemic events were the most common onset symptom (88.9%), followed by hemorrhage (11.1%). The mean follow-up time of digital subtraction angiography examinations was 19.8 ± 20.4 (range 0-108) months. Postoperatively, the majority of collateral vessels showed no changes over time. If changed, deep basal MMA collaterals as well as anterior leptomeningeal collaterals showed a consistent reduction over time, whereas posterior leptomeningeal collaterals, callosal collaterals, and extracranial-intracranial collaterals showed an increase more frequently (p < 0.006). Endogenous collateral vessels developed irrespective of bypass quality, while direct and indirect bypasses showed a synergistic development.</p><p><strong>Conclusions: </strong>This study represents the first longitudinal angiographic characterization of endogenous collateral vessels in Caucasian MMA patients after combined bypass surgery. Collaterals within the region of the anterior circulation supplied by the bypass showed a consistent reduction over time. The development of collaterals depending on the presence and location of the bypass but not its quality indicates the individual endogenous need of moyamoya hemispheres as the determining factor and highlights the enduring plasticity and dynamic nature of the MMA collateral system over time.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630465","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 contemporary, multiinstitutional analysis of transcription factor lineage in pituitary adenomas: comparative study of neuroimaging, histopathology, and clinical outcomes.","authors":"Stephanie K Cheok, Jacob Ruzevick, Robert G Briggs, David J Cote, Ishan Shah, David Gomez, Ilaria Bove, Jeffrey J Feng, Dhiraj J Pangal, Ben A Strickland, Mark Shiroishi, Yana Zavros, Kyle M Hurth, Anna Mathew, Norman E Garrett, Andrew S Little, Edward R Laws, Ana V Castro, Craig M Horbinski, John D Carmichael, Gabriel Zada","doi":"10.3171/2024.10.JNS24853","DOIUrl":"https://doi.org/10.3171/2024.10.JNS24853","url":null,"abstract":"<p><strong>Objective: </strong>Pituitary adenomas (PAs) are common lesions that often present with endocrinopathy and/or visual symptoms. Classification of PAs has historically been based on functional status and histopathological staining of anterior pituitary hormones. In 2017, the WHO revised the classification of PAs, establishing cell lineages identified by the transcription factors (TFs) PIT1, TPIT, and SF1. The clinical behavior of PA subtypes based on TF typing, including growth patterns, response to treatment, and recurrence rates, is unknown. The authors aimed to assess clinical presentation and outcomes according to TF lineage in a contemporary series of PAs.</p><p><strong>Methods: </strong>A retrospective multicenter clinical study of patients undergoing resection of PAs between June 2017 and August 2021 was performed. Included tumors underwent immunohistochemical staining for WHO-defined TFs (TPIT, PIT1, and SF1). Clinical data including demographics, tumor characteristics, extent of resection, and clinical outcomes pertaining to tumor control and hormonal remission were assessed.</p><p><strong>Results: </strong>A total of 238 patients were included in the analysis, with the following clinical breakdown of PA subtypes: nonfunctional PAs (n = 150, 63.0%); growth hormone-secreting PAs causing acromegaly (n = 53, 22.3%); adrenocorticotropic hormone-secreting PAs causing Cushing's disease (n = 30, 12.6%); and prolactinomas (n = 2, 0.8%). The most common TFs identifying cell lineages were SF1 (n = 104 samples, 43.7%), TPIT (n = 53, 22.3%), and PIT1 (n = 46, 19.3%). Thirty-five samples (14.7%) were positive for two TFs. Prevalence of suprasellar extension was highest in SF1 tumors (91.3%) and lowest in PIT1 tumors (54.3%), and varied significantly across groups (p < 0.001). Cavernous sinus and clival/sphenoid invasion also varied among TF subtypes, with the highest rates seen in PIT1 PAs (p = 0.002). Although no significant differences in progression-free survival (PFS) were noted across TF subtypes, among nonfunctional PAs the median PFS for SF1, PIT1, and TPIT TFs were 83 months, 26 months, and 45 months, respectively (p = 0.002). Nonfunctional PIT1 PAs had a significantly shorter PFS/recurrence-free survival compared to functional PIT1 tumors (HR 59.45, 95% CI 2.54-1394, p = 0.01).</p><p><strong>Conclusions: </strong>The modern WHO diagnosis of PAs incorporates pituitary TF staining to standardize classification according to PA cell lineage. TF designation is associated with major clinical and endocrine variables including PA extension, extrasellar growth patterns, Ki-67 labeling index, and PFS among patients with PA subtypes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630459","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":"Nervus intermedius sectioning for the treatment of geniculate neuralgia.","authors":"Alexander L Ren, Amirreza Ehsani, David J Park, Amit R Persad, Janet Y Wu, Jennifer C Hall, Michael Zhang, John Choi, Lily H Kim, Risheng Xu, Steven D Chang, Michael Lim","doi":"10.3171/2024.11.JNS241141","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241141","url":null,"abstract":"<p><strong>Objective: </strong>Geniculate neuralgia (GN) is a rare facial pain syndrome characterized by severe stabbing pain in the ear canal. The exact cause of GN remains unclear; however, it is thought that the nervus intermedius (NI) is the primary implicated structure. When medical management fails, surgical interventions are offered to treat the pain. This study aimed to present a consecutive series of patients with GN who underwent craniotomy with NI sectioning, to offer insights into the safety and efficacy of the surgical approach.</p><p><strong>Methods: </strong>A retrospective review of consecutive institutional medical records from January 2000 to February 2024 identified patients diagnosed with GN who underwent surgical treatment. Patient records were manually reviewed for information regarding patient demographics, comorbidities, medication history, surgical techniques, and outcomes.</p><p><strong>Results: </strong>The study included 47 NI sectioning procedures in 45 patients with GN (mean age 45.5 years). Most patients had concurrent trigeminal neuralgia (TN) and approximately one-third of patients had concurrent TN and glossopharyngeal neuralgia. Surgical procedures involved NI sectioning, often alongside microvascular decompression (MVD) for cranial nerves (CNs) V or IX/X/XI, with favorable early postoperative pain relief. Of 47 procedures, 38 (80.9%) improved pain (Barrow Neurological Institute [BNI] pain intensity score < IV) and 32 (68.1%) resolved pain (BNI score I) by the latest follow-up visit. There was a low incidence of complications, with 2 cases of unexpected hearing loss among all patients, no instances of permanent facial paralysis, and 1 case of permanent vestibular dysfunction. Additionally, 3 patients reported experiencing loss of taste following surgery.</p><p><strong>Conclusions: </strong>This case series suggests that NI sectioning is safe and likely efficacious in relieving the primary deep ear pain of GN, with a potential additive benefit when performed with MVD on CNs V or IX/X/XI, as needed. Further research is needed to refine treatment guidelines and clarify NI-specific otalgia given the overlapping innervation of the inner ear with other CNs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630468","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":"Effect of cumulative dexamethasone dose on the outcome of patients with radiosurgically treated brain metastases in the era of modern oncological therapy.","authors":"Anna Cho, Brigitte Gatterbauer, Yiru Chen, Thore Jankowski, Lukas Haider, Sonja Tögl, Irene Kapfhammer, Martin Schreder, Klaus Kirchbacher, Sabine Zöchbauer-Müller, Karl Rössler, Christian Dorfer, Philippe Dodier, Maximilian J Hochmair, Josa M Frischer","doi":"10.3171/2024.12.JNS241771","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241771","url":null,"abstract":"<p><strong>Objective: </strong>Recent treatment guidelines state that in patients with asymptomatic brain metastases (BMs), local treatment can be delayed until there is evidence of intracranial progression. However, while patients with symptomatic BMs typically require dexamethasone treatment, recent data on the impact of this medication on the outcomes of patients with BMs are lacking. Therefore, the authors conducted a prospective study to evaluate concomitant dexamethasone treatment in a population of radiosurgically treated patients with BMs from non-small cell lung cancer (NSCLC).</p><p><strong>Methods: </strong>This prospective observational study included 129 radiosurgically treated patients with NSCLC BMs, a Karnofsky Performance Status ≥ 70, and no previous radiosurgical treatment. Patients were enrolled in the study between December 2019 and May 2023. For patient allocation, data on concomitant immunotherapy (IT) or targeted therapy (TT) and dexamethasone treatment were analyzed 30 days before and after the first Gamma Knife radiosurgery treatment (GKRS1). A cumulative dose threshold of 100 mg of dexamethasone was evaluated.</p><p><strong>Results: </strong>The estimated median survival time after GKRS1 was significantly longer in female patients than in male patients and in patients with concomitant IT or TT versus those without. Of note, patients with a cumulative concomitant dexamethasone dose ≥ 100 mg at GKRS1 had a significantly shorter median survival after GKRS1 than the patients with a dose < 100 mg. Moreover, a univariable followed by multivariable Cox regression model revealed that a cumulative dexamethasone dose ≥ 100 mg at GKRS1 and male sex were independent prognostic factors for an increased risk of death.</p><p><strong>Conclusions: </strong>A cumulative dexamethasone dose ≥ 100 mg within 30 days before and after radiosurgery was identified as an independent risk factor for death. Consequently, even in the modern oncological era, the recommendation to delay local BM treatment should be critically reviewed, as the main reason for dexamethasone treatment is the presence of neurological symptoms caused by larger BMs and perifocal edema. Thus, the study data support early local BM treatment to avoid dexamethasone treatment for neurological symptoms caused by progressive BMs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630462","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. Enhancing application of the Geriatric Nutritional Risk Index in preoperative assessment.","authors":"Simeng Gao, Jingru Han, Jianfu Zhao","doi":"10.3171/2024.12.JNS242952","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242952","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630463","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":"Navigating the digital frontier: reflecting on a decade of social media in neurosurgery.","authors":"Faith C Robertson, Lior Elkaim, Paolo Palmisciano, Nathan A Shlobin, Emal Lesha, James T Rutka","doi":"10.3171/2025.2.JNS242732","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242732","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630466","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":"Machine learning-based model to predict long-term tumor control and additional interventions following pituitary surgery for Cushing's disease.","authors":"Yuki Shinya, Abdul Karim Ghaith, Sukwoo Hong, Dana Erickson, Irina Bancos, Justine S Herndon, Caroline J Davidge-Pitts, Ryan T Nguyen, Antonio Bon Nieves, Miguel Sáez Alegre, Ramin A Morshed, Carlos D Pinheiro Neto, Maria Peris Celda, Bruce E Pollock, Fredric B Meyer, John L D Atkinson, Jamie J Van Gompel","doi":"10.3171/2024.10.JNS241338","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241338","url":null,"abstract":"<p><strong>Objective: </strong>In this study, the authors aimed to establish a supervised machine learning (ML) model based on multiple tree-based algorithms to predict long-term biochemical outcomes and intervention-free survival (IFS) after endonasal transsphenoidal surgery (ETS) in patients with Cushing's disease (CD).</p><p><strong>Methods: </strong>The medical records of patients who underwent ETS for CD between 2013 and 2023 were reviewed. Data were collected on the patient's baseline characteristics, intervention details, histopathology, surgical outcomes, and postoperative endocrine functions. The study's primary outcome was IFS, and the therapeutic outcomes were labeled as \"under control\" or \"treatment failure,\" depending on whether additional therapeutic interventions after primary ETS were required. The decision tree and random forest classifiers were trained and tested to predict long-term IFS based on unseen data, using an 80/20 cohort split.</p><p><strong>Results: </strong>Data from 150 patients, with a median follow-up period of 56 months, were extracted. In the cohort, 42 (28%) patients required additional intervention for persistent or recurrent CD. Consequently, the IFS rates following ETS alone were 83% at 3 years and 78% at 5 years. Multivariable Cox proportional hazards analysis demonstrated that a smaller tumor diameter that could be detected by MRI (hazard ratio 0.95, 95% CI 0.90-0.99; p = 0.047) was significantly associated with greater IFS. However, the lack of tumor detection on MRI was a poor predictor. The ML-based model using a decision tree model displayed 91% accuracy (95% CI 0.70-0.94, sensitivity 87.0%, specificity 89.0%) in predicting IFS in the unseen test dataset. Random forest analysis revealed that tumor size (mean minimal depth 1.67), Knosp grade (1.75), patient age (1.80), and BMI (1.99) were the four most significant predictors of long-term IFS.</p><p><strong>Conclusions: </strong>The ML algorithm could predict long-term postoperative endocrinological remission in CD with high accuracy, indicating that prognosis may vary not only with previously reported factors such as tumor size, Knosp grade, gross-total resection, and patient age but also with BMI. The decision tree flowchart could potentially stratify patients with CD before ETS, allowing for the selection of personalized treatment options and thereby assisting in determining treatment plans for these patients. This ML model may lead to a deeper understanding of the complex mechanisms of CD by uncovering patterns embedded within the data.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630464","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":"Is there a clinical benefit of S100B for the management of mild traumatic brain injury?","authors":"Rebecca Wagner, Thomas Haider, Rita Babeluk, Franz Marhold, Stefan Hajdu, Anna Antoni","doi":"10.3171/2024.10.JNS241516","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241516","url":null,"abstract":"<p><strong>Objective: </strong>Mild traumatic brain injuries (mTBIs) account for approximately 90% of traumatic brain injuries and are a common cause for hospitalization. Cranial CT (CCT) is the preferred diagnostic tool, but 85%-99% of mTBI patients show no visible lesions on CCT, making its use controversial due to radiation risks and costs. To identify mTBI patients requiring CCT, serum S100B concentrations have been integrated in international guidelines. However, its short half-life and low specificity to detect intracranial hemorrhages (IHs) in mTBI are frequently discussed limitations. The aim of this study was to determine the clinical benefit of S100B in reducing unnecessary CCT studies at a high-volume trauma center.</p><p><strong>Methods: </strong>The authors retrospectively analyzed the data of mTBI patients who were admitted to an urban level I trauma center between January 2017 and December 2022. They included all adult mTBI patients who underwent S100B measurement and had a subsequent CCT study. Patients who underwent immediate CCT on admission per the Canadian CT Head Rule or in the case of antithrombotic therapy were excluded.</p><p><strong>Results: </strong>A total of 391 patients with a mean age of 46 years were included. IH was detected in 23 mTBI patients (5.9%), with 2 patients (0.51%) requiring neurosurgical intervention. The mean S100B level was 0.21 μg/L (range 0.03-2.27 μg/L), with a cutoff at 0.105 μg/L. Patients with positive CCT findings had a mean S100B level of 0.31 μg/L, compared with 0.21 μg/L for negative CCT cases (p = 0.011). IHs occurred in 6.1% of patients with elevated S100B levels and in 4.2% of patients with normal S100B values. The specificity of S100B for positive CCT findings was 12.5%, with a positive predictive value of 6.1% and a negative predictive value of 95.8%. False-positive results led to 57 unnecessary CCT studies annually.</p><p><strong>Conclusions: </strong>This study emphasizes the need for careful consideration when integrating S100B into mTBI management protocols for patients with a low risk for IHs. The low specificity in a younger population suggests that the risks of radiation from unnecessary CCT studies may outweigh the benefits. Although international guidelines were followed, integrating S100B into the mTBI protocol did not reduce CCT use as expected. In the absence of ongoing or new onset of neurological symptoms, elevated S100B values should not trigger CCT studies in a low-risk mTBI population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575856","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":"Measurement of CSF flow and brain motion in Chiari malformation type I subjects undergoing posterior fossa decompression surgery.","authors":"Grace McIlvain, Brice Williams, Mohamad Motaz Al Samman, Saeed Mohsenian, Daniel L Barrow, Francis Loth, John N Oshinski","doi":"10.3171/2024.11.JNS241509","DOIUrl":"https://doi.org/10.3171/2024.11.JNS241509","url":null,"abstract":"<p><strong>Objective: </strong>Radiologically, Chiari malformation type I (CM-I) is characterized by cerebellar tonsil herniation of at least 5 mm through the foramen magnum. In symptomatic cases, posterior fossa decompression (PFD) surgery is often performed and improves symptoms in approximately 75% of patients. However, the surgery involves risks, and identifying which candidates will benefit from surgery is important. It has previously been shown that the amount of tonsillar descent does not correlate with symptom severity or surgical outcomes. The authors hypothesized that using advanced neuroimaging methods to directly measure CSF flow and brain motion will give insights regarding which patients have the greatest likelihood of cerebral dynamic improvements from surgery.</p><p><strong>Methods: </strong>Here, the authors evaluated 108 CM-I patients (age 19-70 years), 61 of whom underwent PFD surgery. The authors used phase-contrast MRI to measure CSF flow/stroke volume and cine displacement encoding with stimulated echoes (DENSE) imaging to measure brain motion, with a goal to predict postsurgical cerebral dynamic improvements from presurgical images.</p><p><strong>Results: </strong>The authors found that CSF stroke volume increased after PFD surgery by 28.9% (p = 0.014), brainstem motion decreased after surgery by 17.3% (p = 0.002), and cerebellum motion decreased 45.2% (p < 0.001). Notably, the amount of CSF flow increase after surgery had no relationship to tonsillar descent (R = 0.059, p = 0.767) but did relate to the amount of presurgical CSF flow (R = -0.518, p = 0.005). Likewise, improvements to brain motion were better predicted by the amount of presurgical motion (brainstem, R = -0.638, p < 0.001; cerebellum, R = -0.878, p < 0.001) than by tonsillar descent (brainstem, R = -0.312, p = 0.093; cerebellum, R = -0.620, p < 0.001).</p><p><strong>Conclusions: </strong>Here, the authors found that presurgical measures of cerebral dynamics were more descriptive of improvements to CSF flow and brain motion after PFD surgery than the conventional measure of presurgical tonsillar descent. These expanded quantitative assessments to determine which patients may benefit from surgery could improve the overall quality of patient care.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575877","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 efficacy of combining pulsed radiofrequency with low-temperature continuous radiofrequency for the treatment of primary trigeminal neuralgia: a randomized controlled trial.","authors":"Chunmei Zhao, Hao Ren, Niti Shrestha, Lan Meng, Ying Shen, Fang Luo","doi":"10.3171/2024.10.JNS241274","DOIUrl":"https://doi.org/10.3171/2024.10.JNS241274","url":null,"abstract":"<p><strong>Objective: </strong>Pulsed radiofrequency (PRF) combined with low-temperature continuous radiofrequency (CRF) might be a novel technique for relieving trigeminal neuralgia (TN). This study aimed to evaluate the efficacy and safety of high-voltage PRF combined with low-temperature CRF in primary TN.</p><p><strong>Methods: </strong>This randomized controlled trial was performed between December 2, 2020, and October 26, 2022. Eligible patients with TN were randomly assigned at a 1:1 ratio to receive either PRF with a voltage of 70 V at 42°C for 600 seconds followed by CRF at 60°C for 270 seconds (PRF+CRF group) or PRF with a voltage of 70 V at 42°C for 600 seconds (PRF group). The primary outcome was the response rate to treatment after 12 months. The secondary outcomes were the proportion of responders at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months following the procedure and the 11-point numeric rating scale (NRS) scores at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months following the procedure. Adverse events associated with surgery were also observed.</p><p><strong>Results: </strong>A total of 169 patients with TN were screened, and 146 patients were randomized. The groups were well balanced across baseline characteristics. The percentage of responders at 12 months after surgery was significantly greater in the PRF+CRF group compared with the PRF group (83.6% [61/73] vs 67.1% [49/73], risk ratio 1.2 [95% CI 1.0-1.5], absolute difference 16.5%; p = 0.021). There was a higher proportion of responders after 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months (ratio difference 16.5%, 35.6%, 16.4%, 12.3%, 12.3%, 12.3%, and 15.1%, respectively; all p < 0.05). Moreover, lower NRS scores were observed in the PRF+CRF group at 1 day, 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months, and 12 months following the procedure (all p < 0.05). Postoperative facial numbness scores were higher in the PRF+CRF group at 1 day, 1 week, 2 weeks, 1 month, and 2 months (all p < 0.05). Overall, 5.5% of patients in the PRF+CRF group and no patients in the PRF group reported masseter muscle weakening. No other complications, such as anesthesia dolorosa and corneal anesthesia, were observed in either group.</p><p><strong>Conclusions: </strong>High-voltage PRF combined with low-temperature (60°C) CRF could provide a significant improvement compared with high-voltage PRF alone. Clinical trial registration no.: NCT04174443 (ClinicalTrials.gov).</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575881","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}