Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Multimodal minimally invasive therapies for CSDH with membranous complexity.","authors":"Zhili Qiao, Cheng Wang, Xiaolin Du","doi":"10.3171/2025.3.JNS25595","DOIUrl":"https://doi.org/10.3171/2025.3.JNS25595","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293907","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 aphasia on verbal memory: insights from the Selective Anesthesia for Functional Evaluation.","authors":"Hana Kikuchi, Shin-Ichiro Osawa, Kazuo Kakinuma, Shoko Ota, Kazuto Katsuse, Kazushi Ukishiro, Kazutaka Jin, Hidenori Endo, Nobukazu Nakasato, Kyoko Suzuki","doi":"10.3171/2025.2.JNS242534","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242534","url":null,"abstract":"<p><strong>Objective: </strong>The Wada test, an intracarotid amobarbital procedure, is the gold standard for the preoperative evaluation of postoperative memory decline in patients with drug-resistant epilepsy. However, because the anesthetic perfuses the language areas, infusion into the language-dominant hemisphere also causes aphasia. Although it has been noted that aphasia may affect verbal memory scores in the Wada test, the extent of the effects has not been verified. This study aimed to examine the extent to which verbal memory is affected by aphasia induced by selective anesthetization of the proximal middle cerebral artery (M1) area (which does not affect the hippocampus) in patients with drug-resistant epilepsy.</p><p><strong>Methods: </strong>This single-center retrospective analysis included patients with drug-resistant epilepsy who underwent the Selective Anesthesia for Functional Evaluation (SAFE) as a preoperative evaluation between May 2018 and December 2023. SAFE includes cognitive tasks of equal difficulty administered before and immediately after anesthetic infusion. The preinfusion assessments confirmed the baseline, whereas the postinfusion assessments evaluated brain function under selective anesthesia. The patients were required to memorize 8 words and 8 pictures. After the anesthetic effects subsided, recognition tasks were performed for both words and pictures. The number of words and pictures successfully recognized were counted as verbal and visual memory scores, respectively. Memory scores were compared between the left and right M1 infusions.</p><p><strong>Results: </strong>Of the 180 SAFE trials conducted during the study period, 38 trials (25 left and 13 right M1 infusions) in 29 patients with confirmed left language dominance and propofol infusion into the M1 were included. All left M1 infusions induced aphasia without causing significant disturbances in consciousness that could have interfered with task completion. The results indicated significantly lower verbal memory scores during left M1 infusions than during right M1 infusions, whereas the visual memory scores were comparable.</p><p><strong>Conclusions: </strong>The verbal memory score was significantly lower after infusion into the M1 of the language-dominant hemisphere than into the nondominant hemisphere, suggesting that aphasia during stimulus encoding may impair verbal memory. Thus, the Wada test with intracarotid anesthetic infusion may not accurately assess memory function due to aphasia. This study highlights the utility of SAFE in reducing aphasic interference in verbal memory, leading to a more accurate evaluation of surgical candidacy in patients with epilepsy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293905","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. Exploring the potential risks of the endoscopic transorbital approach.","authors":"Xi-Yao Feng, Zhi-Qiang Li","doi":"10.3171/2025.3.JNS25515","DOIUrl":"https://doi.org/10.3171/2025.3.JNS25515","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293906","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":"Examining the viability of modern endoscopic endonasal surgery as a first-line treatment for macroprolactinomas: a multicentric study on the results and significance of the highest preoperative prolactin level in predicting long-term surgical outcomes.","authors":"Mehdi Khaleghi, Kristin Michelle Huntoon, Ingrid Marijke Zandbergen, Timothy G White, Leontine Erica Henriëtte Bakker, Marco Johanna Theodorus Verstegen, Luma Mudhafar Ghalib, Iris Catharina Maria Pelsma, Danielle Golub, Alexander Kuffer, Amir R Dehdashti, Nienke Ruurdje Biermasz, Daniel M Prevedello","doi":"10.3171/2025.1.JNS241645","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241645","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;As modern endoscopic endonasal surgery (EES) becomes increasingly refined, patients with large prolactinomas may seek alternatives to lifelong dopamine agonist (DA) therapy. This may raise interest in reassessing potential treatment paradigms and surgical outcomes, particularly in patients who have had long-standing symptoms and sought a more definitive solution. The objective of this study was to explore the viability of EES in experienced centers as a reliable alternative to managing macroprolactinomas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multicentric cohort of patients with histologically proven macroprolactinoma treated with EES over 12 years was retrospectively reviewed. Early surgical results and the determinant factors of outcome were analyzed using a multivariate regression model and Kaplan-Meier curves.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 76 patients with a mean ± SD age of 42.1 ± 15.6 years and tumor diameter of 22.7 ± 12.1 mm was included. Gross-total resection (GTR) was achieved in 56.6%, with Knosp grade (OR 0.167, CI 0.044-0.633, p = 0.008) and clival invasion (OR 0.119, CI 0.019-0.765, p = 0.025) being the only independent predictors. Short-term remission (52/76 patients [68.4%]) was less frequent in patients with cystic tumors (OR 0.004, CI 0.0001-0.0911, p = 0.04) and was higher in those with intended (OR 36.375, CI 1.627-813.128, p = 0.023) or achieved (OR 32.341, CI 1.487-703.558, p = 0.027) GTR in multivariate analysis. The second half of the learning curve showed early complication rates of 41% versus 16.2% in the first half (p = 0.01). During a mean 47.9 ± 33 months of follow-up, the permanent complication rate was 6.6% and 3/51 patients (5.9%) had recurrence. Overall 4-year recurrence-free survival was significantly lower in DA-dependent patients (70% vs 100%, p &lt; 0.001). Last follow-up prolactin levels were positively correlated with postoperative day 1 levels (correlation coefficient 0.403, p &lt; 0.001), with final normoprolactinemia rates significantly higher in the GTR group than in the non-GTR group (76.7 vs 45.2%, p = 0.005). DA-resistant/intolerant patients achieved significant prolactin levels reduction (576 to 17 µg/L, p &lt; 0.001), with normal prolactin level in 51.1% of patients and long-term remission in 35.6%. The overall long-term DA-free remission rate was 39.3%, with the highest preoperative prolactin level (OR 0.999, CI 0.996-0.998, p = 0.042) being the only independent predictor of failure. Subgroup analysis showed remission rates of 80% versus 23.9% in patients with the highest preoperative prolactin levels &lt; 150 versus ≥ 150 µg/L, respectively (p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The authors found that modern EES in multidisciplinary centers was a low-morbid option for patients with macroprolactinoma. Remission rates were consistent with those of recent studies with variably sized prolactinomas, and recurrence rates were low. Although not universally definitive","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248338","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":"Sixto Obrador (1911-1978), Spain's father of neurosurgery: his quest to raise its practice to world-class scientific standards.","authors":"Ruth Prieto, Laura Barrios, José M Pascual","doi":"10.3171/2025.2.JNS242364","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242364","url":null,"abstract":"<p><p>Sixto Obrador Alcalde (1911-1978) played a leading role in developing neurosurgery in Spain, where the specialty began relatively late because of the Spanish Civil War (1936-1939). After earning his medical degree, Obrador collaborated in neurophysiological and neuropathological studies at the Cajal Institute. There, he met Santiago Ramón y Cajal and his most distinguished protégé, Pío del Río-Hortega, who put Obrador in contact with the Spanish Board for the Expansion of Scientific Studies and Research (Junta para Ampliación de Estudios e Investigaciones Científicas), which allowed him to train abroad with outstanding figures in the neurological sciences. Charles Sherrington, along with Harvey Cushing disciples Hugh Cairns and Norman Dott, inspired Obrador to practice scientifically oriented nervous system surgery. After a 5-year period in Mexico, Obrador returned to Madrid in 1946. He came back to a ravaged country, where brain operations were scarce and usually performed by general surgeons. Politically connected and boundlessly keen, Obrador endeavored to have neurosurgery recognized as a separate specialty and organized leading neurosurgical departments in Madrid. He exceeded 5000 brain tumor surgeries and 400 published papers, and his international reputation was strengthened by his involvement with the Portuguese-Spanish Society of Neurosurgery, World Federation of Neurosurgical Societies, and European Association of Neurosurgical Societies. Obrador should be credited with resurrecting the Cajal school, which had been broken by the Spanish Civil War, through his establishment of modern scientific-based neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248342","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":"Decreasing delayed cerebral infarction after aneurysmal subarachnoid hemorrhage using active blood clearance and prevention of delayed cerebral ischemia: results of a 16-year patient registry.","authors":"Roland Roelz, István Csók, Manou Overstijns, Marco Bissolo, Theo Demerath, Petra Cimflova, Ralf Watzlawick, Christian Scheiwe, Eva Rohr, Jürgen Buttler, Johannes Pöppe, Nicole Koch, Jürgen Beck, Peter C Reinacher","doi":"10.3171/2025.2.JNS242828","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242828","url":null,"abstract":"<p><strong>Objective: </strong>Active clearance of intracranial blood by intrathecal irrigation, fibrinolysis, and application of vasodilatory drugs may prevent delayed cerebral infarction (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Starting in 2015, the authors gradually implemented four methods for active blood clearance and prevention of delayed cerebral ischemia (ABCD) using urokinase and nimodipine in clinical management. In this paper, the impact of a patient-tailored use of these methods on DCI prevention is reported.</p><p><strong>Methods: </strong>Nine hundred sixty consecutive patients with aSAH admitted between 2008 and 2023 were included. Patients admitted before October 2015 were managed according to international guidelines (before-ABCD cohort, n = 543). ABCD became available in October 2015 and was gradually implemented by four different methods (after-ABCD cohort, n = 417) in patients at high risk for DCI. Nine patients in the after-ABCD cohort who were enrolled in a randomized trial on ABCD and allocated to standard of care were excluded. Cranial imaging was reviewed by an independent board and infarcts were classified as early, iatrogenic, or delayed.</p><p><strong>Results: </strong>After October 2015, 139 (33.3%) of 417 patients were selected for ABCD and the amount of extravasated blood (Hijdra sum score) was the key factor for ABCD use. Stereotactic catheter ventriculocisternostomy was developed in October 2015 and used in 88 patients. Intraoperative placement of a cisternoventricular catheter via the fenestrated lamina terminalis was introduced in 2018 and used in 30 patients. In 2021, ventriculolumbar irrigation and lumbo-lumbar irrigation were developed and used in 18 and 3 patients, respectively. DCI occurred in 115 (21.2%) of 543 patients before versus 32 (7.7%) of 417 patients after ABCD implementation (p < 0.0001). The per-patient DCI burden declined from 38.6 to 11.7 cm3. Neurological outcome was improved in patients with a high blood load (Hijdra score ≥ 30), and 26% after ABCD versus 9% of patients before ABCD achieved a modified Rankin Scale score of 0-3 (p = 0.006).</p><p><strong>Conclusions: </strong>Implementation of ABCD was associated with a low complication rate and a decline of 70% in the per-patient DCI burden. Outcomes were significantly improved in patients with a high blood load.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of calcium phosphate bone cement in retrosigmoid craniotomies to reduce rates of pseudomeningocele and craniotomy-site CSF leakage: a cohort study and meta-analysis.","authors":"Megan M J Bauman, Kevin L Webb, Charlotte E Michaelcheck, Lucas P Carlstrom, Ramin A Morshed, Jamie J Van Gompel, Michael J Link, Maria Peris Celda","doi":"10.3171/2025.1.JNS241076","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241076","url":null,"abstract":"<p><strong>Objective: </strong>Calcium phosphate cement (CPC) use has been previously described as a strategy to reduce the rates of pseudomeningocele and CSF leakage following skull base surgery. The authors aimed to present their institutional experience with CPC in retrosigmoid craniotomy and perform a systematic review of the literature to determine the effectiveness of CPC in reducing postoperative complications, including pseudomeningocele and craniotomy-site CSF leakage.</p><p><strong>Methods: </strong>A retrospective single-institution cohort study of patients who underwent retrosigmoid craniotomy with and without CPC cranioplasty from January 2017 to April 2024 was performed. A systematic literature review and meta-analysis of CPC use in retrosigmoid craniotomy was also performed.</p><p><strong>Results: </strong>Of 336 patients who underwent retrosigmoid craniotomy, 193 (57%) were female and the median age at surgery was 55 years (range 18-81 years). The median follow-up duration was 23 months (range 3-80 months). CPC was used to seal the edge of the craniotomy in 66 patients (20%). Among all patients, 50 (15%) experienced a postoperative complication, and 28 (8%) were wound-specific complications. Patients in the non-CPC group experienced significantly more postoperative wound-specific complications than those in the CPC group (10% vs 0%, p = 0.002). Specifically, pseudomeningocele occurred in 0 patients (0%) in the CPC group compared with 24 patients (9%) in the non-CPC group (p = 0.006), which progressed to CSF leaks at the craniotomy site in 6 patients (p = 0.60). Additionally, no patients (0%) in the CPC group experienced wound infection, dehiscence, or breakdown compared with 10 patients (4%) in the non-CPC group (p = 0.22). Five patients (8%) in the CPC group reported prolonged mild incisional pain at the craniotomy site, and there were no instances of major complications related to the CPC. In the meta-analysis, 10 studies met the inclusion criteria, yielding a total of 2166 patients (including the current study), 1101 of whom received CPC. In the pooled analysis, CPC was significantly associated with lower risk of CSF leakage at the craniotomy site (OR 0.23, 95% CI 0.13-0.42; p < 0.01) and lower risk of infection (OR 0.17, 95% CI 0.08-0.38; p < 0.01).</p><p><strong>Conclusions: </strong>CPC use in retrosigmoid craniotomies could be a safe and effective strategy to reduce the incidence of pseudomeningocele and craniotomy-site CSF leakage, leading to lower rates of wound-related complications and infection.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248343","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":"Direct delivery of gene- and cell-based therapies to the nervous system. Image-Guided Biologic Therapies: Neurosurgeons Innovating Treatment Excellence Summit summary.","authors":"J Bradley Elder, Bob Carter, Paul S Larson, Brian Dalm, Ellen L Air, Gerald Grant, William S Anderson, Craig van Horne, Hooman Azmi, Samuel Browd, Russell R Lonser","doi":"10.3171/2025.1.JNS241967","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241967","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248337","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":"Comparison of patient-centric factors in minimally invasive transcranial versus classic approaches: a matched cohort study.","authors":"Peter Harris, Hayes H Patrick, Keaton Piper, Jonah Gordon, Edinson Najera, Miguel Sáez-Alegre, Franco Rubino, Harry R van Loveren, Walter C Jean","doi":"10.3171/2025.2.JNS242843","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242843","url":null,"abstract":"<p><strong>Objective: </strong>The principal tenet of minimally invasive neurosurgery is to limit approach-related tissue trauma, and a major assumption is that shorter incisions and smaller openings, in addition to protecting the brain, also have some perceptible benefits for the patient. This study tests the assumption of patient benefit and tries to define its significance.</p><p><strong>Methods: </strong>Procedures that fit the inclusion criteria of minimally invasive transcranial \"keyhole\" surgery were sought in the principal investigator's archives. Each case was then paired with a classic procedure performed within the study time frame by the two senior authors, matched for pathology, size, location, and complexity. These pairs were then compared using a statistical tool (i.e., the Wilcoxon signed-rank test) designed for matched samples. Differences in estimated blood loss, duration of surgery, and length of hospital stay were examined. The narcotic needs during hospitalization were also examined as morphine milligram equivalent (MME).</p><p><strong>Results: </strong>Ninety patients were included in this study, evenly split between the minimally invasive surgery (MIS) and classic cohorts. Comparison of the 45 pairs showed no significant difference in estimated blood loss, though the operative times favored the MIS cohort significantly (mean ± SEM 310 ± 17 minutes vs 383 ± 24 minutes, p = 0.02). The length of stay was shorter for MIS, but the difference reached statistical significance only when cases with complications were excluded. The most important finding was that significantly less narcotic was needed during hospitalization in the MIS cohort (83 ± 15 MME vs 257 ± 47 MME).</p><p><strong>Conclusions: </strong>The large difference in narcotic needs points to enhanced recovery from MIS techniques. While the difference in operative time did not lead to significantly shorter hospital stays, data suggest that minimally invasive technique may benefit the patient during recovery. This inspires further investigations to define the potentially positive impact on hospital and healthcare systems.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248335","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":"Fiber orientation distribution for detecting skull base tumor histopathology: technical note and retrospective 81-case series.","authors":"Timothée Jacquesson, Audrey Comte, Manon Aubert, Morgane Des Ligneris, Emeric Desmazure, Lise Goichot, Emmanuel Jouanneau, Noémie Kurland, Stéphane Tringali, Carole Frindel, François Cotton","doi":"10.3171/2025.3.JNS242264","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242264","url":null,"abstract":"<p><strong>Objective: </strong>Skull base tumor surgery remains challenging because these tumors are deeply seated and trapped within numerous cranial nerves and vessels. Accurate histopathological analysis of skull base tumors will strongly impact their further management. Yet, currently there is no noninvasive validated method to confirm their diagnosis. In a recent study of MRI tractography, the authors used fiber orientation distribution (FOD) and noted that this diffusion model formed a pattern that could correspond to the histopathological type of skull base tumors. The aim of this study was to propose a new imaging method for skull base tumors that can detect the diagnosis according to the FOD pattern.</p><p><strong>Methods: </strong>From an 81-case series of skull base tumors, MRI diffusion images were investigated by 3 independent observers. Diffusion patterns were classified as centrifugal, wrapped, and chaotic, corresponding to meningiomas, schwannomas, and epidermoid cysts, respectively.</p><p><strong>Results: </strong>The overall identification rate was 80.7%, with an excellent concordance between the 3 observers (Fleiss's κ coefficient = 0.765, p < 0.0001). The identification rate increased along with the observers' anatomoradiological expertise (72.8%, 77.8%, and 91.4%, for observer 1 [low expertise], 2 [average expertise], and 3 [extensive expertise], respectively) and was higher for schwannomas (88.6%), than meningiomas (72.6%) and epidermoid cysts (66.7%).</p><p><strong>Conclusions: </strong>This new imaging tool could assist in complex skull base tumor identification and characterization, as well as surgical management.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248339","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}