Journal of neurosurgery最新文献

{"title":"Prolactinomas and Knosp grade: when is surgery the appropriate choice? A systematic review and meta-analysis.","authors":"Sebastian Ordoñez-Cure, Maria José Uparela-Reyes, Santiago Cardona-Collazos, Adrián David Fernández-Osorio, Javier Orozco","doi":"10.3171/2025.5.JNS243092","DOIUrl":"https://doi.org/10.3171/2025.5.JNS243092","url":null,"abstract":"<p><strong>Objective: </strong>Prolactinomas are the most common type of pituitary adenoma. Historically, surgery was the primary treatment, but the introduction of dopaminergic agonists in the 1970s changed therapeutic practices. Recent guidelines (2023) from the Pituitary Society now recommend surgery as the first-line option for select prolactinomas, particularly those with certain grades as defined by the Knosp classification system. This systematic review and meta-analysis was performed to evaluate the safety of and the biochemical remission rates following resection of prolactinomas classified preoperatively by Knosp grade.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted across the MEDLINE (via PubMed), Scopus, Web of Science, LILACS (Latin American and Caribbean Literature on Health Sciences), and Cochrane CENTRAL (Central Register of Controlled Trials) databases from inception to February 2024. Eligible studies reported individual participant data on the biochemical remission and surgical outcomes of patients with prolactinomas stratified by Knosp grade. A random effects meta-analysis was performed to synthesize biochemical remission rates and relative risks, with results presented in forest plots. Subgroup analyses were conducted according to Knosp grade, heterogeneity was assessed using the I2 statistic, prediction intervals were reported, and publication bias was evaluated through funnel plots and Egger's test. This review was registered in the International Prospective Register of Systematic Reviews (registration no.: CRD42024602904) and followed the PRISMA guidelines.</p><p><strong>Results: </strong>Twelve studies involving 1010 patients with prolactinomas undergoing transsphenoidal surgery were included. Prolactinomas classified as Knosp grades 0-2 demonstrated significantly higher biochemical remission rates of 75% (95% CI 67%-82%, prediction interval 42%-96%, I2 = 81.5%, p < 0.0001) compared to 22% (95% CI 16%-31%, prediction interval 11%-38%, I2 = 17.2%, p = 0.57) for Knosp grades 3-4. Transsphenoidal surgery was associated with favorable outcomes characterized by low complication rates and no reported deaths.</p><p><strong>Conclusions: </strong>Resection for Knosp grade 0-2 prolactinomas appears to be an effective first-line treatment option, resulting in favorable biochemical remission rates and low complication risks. These findings support considering surgery in appropriately selected patients, particularly at experienced medical centers. However, the high heterogeneity among and the observational design of most included studies limit the strength of the conclusions. Thus, further studies are needed to compare surgical and medical management strategies across Knosp grades and to refine patient selection.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145053720","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":"Deep learning-powered temperature prediction for optimizing transcranial MR-guided focused ultrasound treatment.","authors":"Yongqin Xiong, Mingliang Yang, Mukadas Arkin, Yan Li, Caohui Duan, Xiangbing Bian, Haoxuan Lu, Luhua Zhang, Song Wang, Xiaojing Ren, Xuemei Li, Ming Zhang, Xin Zhou, Longsheng Pan, Xin Lou","doi":"10.3171/2025.5.JNS25291","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25291","url":null,"abstract":"<p><strong>Objective: </strong>Precise temperature control is challenging during transcranial MR-guided focused ultrasound (MRgFUS) treatment. The aim of this study was to develop a deep learning model integrating the treatment parameters for each sonication, along with patient-specific clinical information and skull metrics, for prediction of the MRgFUS therapeutic temperature.</p><p><strong>Methods: </strong>This is a retrospective analysis of sonications from patients with essential tremor or Parkinson's disease who underwent unilateral MRgFUS thalamotomy or pallidothalamic tractotomy at a single hospital from January 2019 to June 2023. For model training, a dataset of 600 sonications (72 patients) was used, while a validation dataset comprising 199 sonications (18 patients) was used to assess model performance. Additionally, an external dataset of 146 sonications (20 patients) was used for external validation.</p><p><strong>Results: </strong>The developed deep learning model, called Fust-Net, achieved high predictive accuracy, with normalized mean absolute errors of 1.655°C for the internal dataset and 2.432°C for the external dataset, which closely matched the actual temperature. The graded evaluation showed that Fust-Net achieved an effective temperature prediction rate of 82.6%.</p><p><strong>Conclusions: </strong>These results showcase the exciting potential of Fust-Net for achieving precise temperature control during MRgFUS treatment, opening new doors for enhanced precision and safety in clinical applications.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145054252","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":"Molecular landscape and clinical correlates of olfactory groove meningiomas: a multi-institutional study.","authors":"Majd Alkhatib, Lingyang Hua, Friederike Beyer, Insa Prilop, Dino Podlesek, Sanjeeva Jeyaretna, Shingo Fujio, Amir Zolal, Leila Günther, Berfin Cicek, Sylvia Herold, Silke Zeugner, Jerry Hadi Juratli, Daniel P Cahill, Hiroaki Wakimoto, Mario Teo, Ye Gong, Thomas Pinzer, Gabriele Schackert, Ilker Y Eyüpoglu, Priscilla K Brastianos, Tareq A Juratli","doi":"10.3171/2025.4.JNS242619","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242619","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the relationship between the clinical and radiological characteristics of olfactory groove meningiomas (OGMs) and their molecular profiles.</p><p><strong>Methods: </strong>The authors performed targeted next-generation and whole-genome sequencing in 123 OGM samples collected from 4 international institutions, focusing on known meningioma-driver genes. They compared the molecular data with the clinical and radiographic features of the tumors. Patient and tumor data, including age, sex, radiological features, and overall survival, were retrospectively collected and analyzed.</p><p><strong>Results: </strong>The study cohort comprised 90 females (73%) and 33 males (27%), with a median age at diagnosis of 57 years (range 25-87 years). The majority of tumors (88.6%, n = 109) were classified as WHO grade I meningioma. Known driver mutations were found in 86.2% of patients (n = 106), with the most common mutations found in the SMOL412F/W535L and AKT1E17K genes, each present in 36 cases (29.3%), followed by mutations in PIK3CA/PIK3R1 (19 cases, 15.4%; 14 PIK3CA and 5 PIK3R1), TRAF7 alone (7 cases, 5.7%), POLR2AQ403K (4 cases, 3.3%), and TRAF7/KLF4K409Q (3 cases, 2.4%), while 17 patients (13.8%) did not harbor known meningioma driver mutations (wildtype group). Within molecular subgroups, patients with AKT1 mutations were the youngest (median age 51 years, range 30-87 years) and patients with TRAF7-only mutations were the oldest (median 66 years, range 28-76 years). The median tumor volume at diagnosis was 18.04 cm3. SMO-mutant tumors were significantly larger (median volume 19.5 cm3) than both AKT1-mutant (median 7.5 cm3, p = 0.021) and TRAF7/KLF4-mutant (median 4.9 cm3, p = 0.002) tumors. Tumor-associated hyperostosis of the sphenoid planum was common (58.5%), led by PIK3CA/PIK3R1, SMO, and wildtype groups (73.7%, 72.2%, and 70.6%, respectively), compared with a notably lower rate in AKT1-mutant tumors (25%) (p < 0.001). Tumor invasion of the ethmoid sinuses occurred most frequently in the TRAF7-only mutant OGMs (42.9%), followed by PIK3CA/PIK3R1-mutant (31.6%) and wildtype (23.5%) OGMs. The mean progression-free survival (PFS) was 144.4 months (95% CI 123.8-165 months). Patients with SMO-mutant OGMs exhibited a significantly shorter mean PFS of 92.0 months (95% CI 70.1-113.9 months) compared with 158.2 months (95% CI 134.9-181.5 months) for SMO-wildtype OGMs (p = 0.004), identifying a tumor type that might benefit from adjuvant treatment after resection.</p><p><strong>Conclusions: </strong>This study revealed that 70% of OGMs harbor SMO, AKT1, and PIK3CA mutations, influencing tumor behavior, symptoms, and outcomes, supporting molecular profiling for personalized treatment in OGM management.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006293","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":"Noninvasive assessment of glymphatic system alterations as potential biomarkers for predicting overall survival in glioma.","authors":"Qian Li, Xuetong Tao, Xuanle Li, Xiqian Zhang, Heng Wang, Jing Qin, Jia Gu, Rongde Zhong, Na Zhang","doi":"10.3171/2025.5.JNS243268","DOIUrl":"https://doi.org/10.3171/2025.5.JNS243268","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;In this retrospective study, authors aimed to evaluate the glymphatic function alterations associated with glioma and explore the prognostic value of these alterations by calculating the index for diffusivity along the perivascular space (ALPS index).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors utilized data from the publicly available University of California San Francisco Preoperative Diffuse Glioma MRI (UCSF-PDGM) dataset, which includes 501 adult patients with histopathologically confirmed diffuse glioma, per the 2021 WHO classification, who underwent preoperative MRI, initial tumor resection, and tumor genetic testing at a single medical center from 2015 to 2021.The ALPS index was calculated from diffusivity maps for noninvasive glymphatic system (GS) analysis. The authors extracted 2288 radiomic features across four tumor regions: surrounding FLAIR abnormality, enhancing tumor, central nonenhancing and/or necrotic tumor, and whole tumor (combining necrosis, enhancement, and edema). For normally distributed variables (adjusted for age, enhancing tumor volume, and surrounding FLAIR abnormality volume), ANCOVA was utilized; nonnormally distributed data were analyzed using the Kruskal-Wallis test and Mann-Whitney U-test. Spearman's correlation coefficients were calculated to assess relationships between radiomic features and the ALPS index. Survival analysis included Kaplan-Meier curves, log-rank tests, concordance index (C-index), calibration and decision curves, and Cox regression.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Ultimately, 437 patients with grade 2-4 gliomas were included in this study. The mean patient age was 57.46 ± 14.84 years, and 261 patients were male. The ALPS index correlated most strongly with shape features in the surrounding FLAIR abnormality region (MajorAxisLength, which measures elongation of the edema region, r = -0.33, p &lt; 0.001), intensity features in the enhanced region (T2.RootMeanSquared, which quantifies variations in T2-weighted MRI signal intensity, r = 0.25, p &lt; 0.001), and both shape and texture features in the necrotic region (Sphericity, which reflects the roundness of necrosis, r = 0.26, p &lt; 0.001; FLAIR.glszm.GLNU, which reflects the uniformity of MRI signal distribution, r = -0.24, p &lt; 0.001). Patients with higher-grade tumors (p &lt; 0.001), IDH-wildtype glioma (p = 0.01), and 1p19q-intact tumors (p = 0.038) consistently exhibited reduced glymphatic function. Univariate Cox regression analysis demonstrated that a lower ALPS index was related to a shorter survival time (HR 0.297, 95% CI 0.149-0.593, p &lt; 0.001). Subgroup analyses within histological and molecular subtypes (grade 4, IDH wildtype, and 1p19q intact) demonstrated that patients with ALPS values below the median had significantly shorter overall survival. The ALPS index combined with radiomics improved survival prediction, with the C-index increasing from 0.709 to 0.711 in the training cohort and from 0.675 to 0.693 in the","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006223","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":"Activity performance in patients with traumatic brachial plexus injuries after elective amputation and myoelectric hand prosthetic fitting.","authors":"Tiam M Saffari, Andrew W Nelson, Brandon P Sampson, Fantley C Smither, Nicholas Pulos, Robert J Spinner, Allen T Bishop, Alexander Y Shin","doi":"10.3171/2025.5.JNS242795","DOIUrl":"https://doi.org/10.3171/2025.5.JNS242795","url":null,"abstract":"<p><strong>Objective: </strong>The role of amputation and myoelectric prosthetic fitting for hand function in traumatic pan-brachial plexus injury (pBPI) continues to evolve. This study evaluated the function and activity performance of patients with traumatic pBPI who underwent amputation and prosthetic fitting with a myoelectric prosthesis (MEP) for hand function.</p><p><strong>Methods: </strong>A retrospective analysis of adult patients who underwent elective amputation after sustaining a pBPI followed by MEP for hand function was performed. Demographics, mechanisms of injury, amputation details, and outcomes were collected from medical records. The Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure was used to evaluate the impact of impairment, the visual analog scale (VAS) to assess pain, and the Activities Measure for Upper Limb Amputees (AM-ULA) to determine functional activity performance pre- and post-MEP usage. Follow-up time, prosthesis usage, satisfaction, and site of electrical signal used were recorded. Paired t-tests were used to compare outcomes.</p><p><strong>Results: </strong>Twenty-one adult patients with pBPI (90% male, mean age 32 years at the time of BPI) underwent amputations and were fitted with MEPs for hand function controlled by nonintuitive signals. Fifteen patients underwent a trans-radial amputation and 6 underwent a trans-humeral amputation. While all patients sought improved terminal grasp function, 3 patients subsequently declined prosthetic fitting after amputation. Of the 18 patients who underwent myoelectric prosthetic hand fittings, linear transducers activated by the contralateral shoulder protraction were used in 66% of patients, and traditional electrode signals from ipsilateral nonintuitive muscle were used in 33% to control MEP grasp function. Disability (DASH) and pain (VAS) scores significantly improved after amputation (p = 0.04 and p < 0.01, respectively). AM-ULA scores showed a significant improvement in activity performance after application of the MEP, with an average increase of 23 points from 0 points on a 40-point scale before amputation and prosthetic fitting (p < 0.0001). Daily users of the MEP averaged 6 hours per day and reported the prosthesis was useful during daily activities with great satisfaction at an average of 22 months of follow-up.</p><p><strong>Conclusions: </strong>Amputation followed by MEP fitting in adult traumatic pBPI significantly improved function, reduced pain, and had a high prosthetic usage. The AM-ULA, a tool for quantitatively evaluating activity performance, was applied to measure the bimanual functional activity performance of patients before and after using MEPs, which revealed a significant improvement. Patients reported using their prosthetics daily with a high satisfaction rate with functional terminal grasp and release.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006277","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. Intraosseous needle for cSDH: technical refinements and future directions.","authors":"Dexin Wang, Qing Xiao, Xiaolin Du","doi":"10.3171/2025.5.JNS251247","DOIUrl":"https://doi.org/10.3171/2025.5.JNS251247","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006239","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 comparative assessment of laser interstitial thermal therapy and open resective surgery for drug-resistant epilepsy: a meta-analysis of 3873 patients.","authors":"Diego Pichardo-Rojas, César Bigran Espinosa-Cantú, Alder Fernando Valenzuela-Rangel, Luz Camila Choque-Ayala, Aldo Barrón-Lomelí, Ernesto A Gutierrez-Herrera, Sonia Iliana Mejía Pérez, Pavel S Pichardo-Rojas, Vanessa Milanese, Leonardo Rangel-Castilla","doi":"10.3171/2025.4.JNS25386","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25386","url":null,"abstract":"<p><strong>Objective: </strong>Open resective surgery (ORS) has become the standard of care for focal drug-resistant epilepsy (DRE). However, minimally invasive surgical alternatives, such as laser interstitial thermal therapy (LITT), have also been shown to be safe and effective. A meta-analysis comparing both treatments is warranted to assess the benefits of each modality for focal DRE.</p><p><strong>Methods: </strong>A literature search was conducted until March 14, 2024, to identify studies comparing LITT and ORS in patients with DRE. The primary outcomes included seizure freedom (SF), length of hospital stay (LHS), and complication rate (CR). Subgroup analyses were performed based on age, epilepsy etiology, and propensity score-matched (PSM) studies.</p><p><strong>Results: </strong>Of 558 articles, 15 cohort studies met the authors' inclusion criteria, encompassing 3873 patients for analysis. The rate of SF in the LITT group was 52.5% (95% CI 0.453-0.597, I2 = 47.4%) and 67.1% (95% CI 0.602-0.739, I2 = 57.4%) for the ORS group. LITT showed a significantly lower rate of SF compared to ORS (risk ratio [RR] 0.78, 95% CI 0.70-0.88, p ≤ 0.0001). However, when PSM studies (RR 0.85, 95% CI 0.63-1.15, p = 0.30) and studies on patients with temporal lobe epilepsy (TLE) (RR 0.88, 95% CI 0.67-1.14, p = 0.34) were analyzed, the SF rates were similar. Patients who underwent LITT had a significantly shorter LHS (mean difference 2.95 days, 95% CI 1.12-4.78, p < 0.00001), lower CR (RR 0.54, 95% CI 0.37-0.79, p < 0.002, I2 = 32%), lower rate of ischemic stroke (RR 0.15, 95% CI 0.04-0.65, p = 0.01), and lower rate of permanent neurological deficits (RR 0.13, 95% CI 0.05-0.36, p < 0.0001).</p><p><strong>Conclusions: </strong>Across unmatched studies evaluating focal DRE, ORS showed a higher rate of SF. However, pooled matched-cohort analyses showed no difference between interventions in achieving SF, a trend also noted in the authors' PSM TLE sample. LITT, however, offered significantly shorter LHS and lower CRs. Future prospective studies should match patient populations to control for confounding factors and assess key outcomes, such as postoperative neurocognitive follow-up and quality of life measurements, in order to fully evaluate the risks and benefits of each approach.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-20"},"PeriodicalIF":3.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006290","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":"Deep brain stimulation for treatment-resistant major depressive disorder: a network meta-analysis of stimulation targets.","authors":"Anant Naik, Tiffany Chu, Rishabh Gupta, Bara Saadah, Suma Gangidi, Claire Lee, Peter M Lauro, Samuel W Cramer, Michael C Park, Wael F Asaad, Paul M Arnold","doi":"10.3171/2025.4.JNS242393","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242393","url":null,"abstract":"<p><strong>Objective: </strong>Major depressive disorder is a significant cause of disability, impacting an estimated 193 million individuals worldwide. Forty percent are estimated to have little to no response to standard pharmacological therapies. Deep brain stimulation (DBS) has emerged as a favorable neuromodulation therapy for treatment-resistant depression, but it remains unclear which brain targets are optimal.</p><p><strong>Methods: </strong>The authors performed a systematic literature review and meta-analysis of articles published through January 2022 to examine the efficacy of DBS targets in reducing depressive symptoms in patients with treatment-resistant depression. The primary outcome was the reduction in depression severity measured by the Montgomery-Asberg Depression Rating Scale and Hamilton Rating Scale for Depression. Secondary outcomes were responder and remission rates.</p><p><strong>Results: </strong>The authors analyzed 22 trials, 15 of which were sham-controlled studies. This network meta-analysis identified that stimulation of the medial forebrain bundle (MFB) was associated with the greatest reduction in depressive symptoms, compared with stimulation of the subcallosal cingulate gyrus (SCG) and ventral capsule/ventral striatum (VC/VS). Stimulation of the MFB also exhibited a higher responder rate (86%) than stimulation of the SCG or anterior limb of the internal capsule. Stimulation of the rostral extension of the prefrontal cortex was associated with the highest remission rate (60%), but this was not statistically significant compared with stimulation of other brain regions.</p><p><strong>Conclusions: </strong>The MFB shows promise as a DBS target for treatment-resistant depression, possibly a result of its involvement in the mesocortical and mesolimbic pathways mediating depression. However, additional trials directly comparing stimulation of different brain regions are necessary to establish MFB as the optimal neurostimulation target.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006231","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":"Fully automated image updating for brain shift compensation after dural opening.","authors":"Chengpei Li, Linton T Evans, Jennifer Hong, Scott C Davis, David W Roberts, Keith D Paulsen, Xiaoyao Fan","doi":"10.3171/2025.4.JNS242786","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242786","url":null,"abstract":"<p><strong>Objective: </strong>In open cranial procedures, intraoperative brain shift can degrade the accuracy of surgical navigation on the basis of preoperative MR (pMR) images as soon as the cortical surface is exposed. The aim of this study was to develop a fully automated image updating system to address brain shift at the start of open cranial surgery and to evaluate its accuracy and efficiency.</p><p><strong>Methods: </strong>This study included patients undergoing open cranial procedures at a single center. Intraoperative stereovision (iSV) images of the surgical field were acquired as an easily integrated nondisruptive source of high-resolution image data on surgical surface deformation and were integrated with a computational model to compensate for volumetric brain shift after dural opening by updating the coregistered preoperative images. A Fast Segment Anything Model algorithm segmented the exposed cortical surface on iSV images automatically. Vessel and sulcus features were also segmented automatically from both iSV and pMR images and registered using a two-step registration method. Extracted nonrigid cortical displacements were assimilated by a finite element model to estimate whole-brain deformation. Updated MR (uMR) images were generated by deforming pMR by the resulting displacement field. A tracked stylus sampled the exposed cortical surface to provide independent measurements for error assessments. The uMR images were evaluated in terms of the misfit between model estimates and measured displacements, target registration error (TRE), and point-to-surface distance (PSD) relative to their pMR counterparts.</p><p><strong>Results: </strong>Fifteen patients (age range 45-85 years) who underwent open cranial procedures were included in the study. The overall accuracy of reconstructed iSV surfaces relative to stylus positions was 0.8 ± 0.7 mm. The overall mean misfit, TRE, and PSD of uMR images were 2.1 ± 1.2 mm, 1.9 ± 1.0 mm, and 1.6 ± 1.0 mm, respectively, compared with 6.5 ± 1.3 mm, 6.2 ± 1.2 mm, and 4.5 ± 1.2 mm for pMR images. Image updating was completed automatically without any user intervention in an overall mean of 3.9 ± 0.6 minutes.</p><p><strong>Conclusions: </strong>Automatic image updating compensated for brain shift due to dural opening and achieved clinically acceptable accuracy and efficiency. The system required no user intervention or expertise and caused minimal interruptions to surgical flow, suggesting it has potential for future integration into open cranial procedures.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006234","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":"Association between facility volume with treatment patterns and short-term surgical outcomes in pituitary adenoma: a National Cancer Database analysis.","authors":"John Pham, David Gomez, Ishan Shah, Apurva Prasad, David J Cote, Keiko Kang, Robert G Briggs, Jonathan Sisti, Gabriel Zada","doi":"10.3171/2025.4.JNS25716","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25716","url":null,"abstract":"<p><strong>Objective: </strong>Pituitary adenomas (PAs) are common intracranial neoplasms for which definitive treatment is generally transsphenoidal resection depending on patient and tumor characteristics. Recent studies have demonstrated that patients with other intracranial tumors treated at high-volume centers are more likely to undergo surgery, receive adjuvant therapy, and experience improved surgical outcomes. However, PAs have yet to be studied in this context. The authors investigated the association between facility volume with treatment patterns and short-term surgical outcomes in patients with PA using data from the National Cancer Database (NCDB).</p><p><strong>Methods: </strong>The NCDB was queried for adult patients diagnosed with PA between 2010 and 2021. Facility volume was categorized into quartiles based on the average number of patients managed per year: quartile 1 (Q1, ≤ 8.73), quartile 2 (Q2, 8.74-20.60), quartile 3 (Q3, 20.61-48.40), and quartile 4 (Q4, ≥ 48.41). Multivariable logistic regression models were constructed to assess treatment patterns and short-term surgical outcomes (extended length of stay [> 4 days], unplanned 30-day readmission, 30-day mortality, and 90-day mortality), adjusting for patient sociodemographic and clinical characteristics.</p><p><strong>Results: </strong>A total of 100,471 patients treated at 1227 hospitals were included. The majority of hospitals were in Q1 (79.1%), while 28 hospitals (2.3%) qualified for Q4. Patients at Q4 hospitals were more likely to undergo surgery (OR 2.08, 95% CI 1.97-2.20) and receive medical therapy (OR 2.40, 95% CI 2.24-2.57) compared with patients at Q1 hospitals (both p < 0.001). Endoscopic surgery was more frequently performed at Q4 hospitals (70.8%) than Q1 hospitals (45.0%). Compared with patients at Q1 hospitals, patients at Q4 hospitals demonstrated lower odds of receiving radiotherapy (OR 0.68, 95% CI 0.58-0.80; p < 0.001). Patients treated at Q4 hospitals exhibited a lower likelihood of extended postsurgical length of stay (OR 0.54, 95% CI 0.49-0.59), 30-day mortality (OR 0.42, 95% CI 0.27-0.65), and 90-day mortality (OR 0.52, 95% CI 0.37-0.73) in comparison with patients at Q1 hospitals (all p < 0.001). However, no significant difference in unplanned readmission within 30 days of surgery (OR 0.95, 95% CI 0.79-1.15; p = 0.615) was observed between Q4 and Q1 hospitals.</p><p><strong>Conclusions: </strong>Treatment at higher-volume facilities is associated with higher odds of undergoing surgery, along with significantly lower odds of extended postsurgical length of stay and perioperative mortality. These findings highlight the importance of centralized care at high-volume institutions, where multidisciplinary teams can offer comprehensive management for complex cases.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957433","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}