Journal of neurosurgery最新文献

{"title":"Microsurgical anatomy of the fiber tracts and vascular structures lateral to the internal capsule.","authors":"Chen Li, Guangfu Di, Qiang Li, Lean Sun, Weigong Wang, Yun Wang, Xiaochun Jiang, Jinsong Wu","doi":"10.3171/2025.2.JNS243025","DOIUrl":"https://doi.org/10.3171/2025.2.JNS243025","url":null,"abstract":"<p><strong>Objective: </strong>The cerebral structures lateral to the internal capsule are frequently involved in studies of nervous system functions and diseases. This study aimed to investigate the fiber tracts and vascular structures of the brain lateral to the internal capsule using cranial specimens and specimen perfusion techniques.</p><p><strong>Methods: </strong>Ten cranial specimens were perfused via arteries and veins using specimen perfusion techniques and then processed using the fiber dissection method. The authors studied the fiber tracts and vascular structures from the cerebral cortex to the internal capsule, moving from lateral to medial.</p><p><strong>Results: </strong>The topographical relationships between the fiber tracts, nuclei, and vascular structures were identified. This was achieved by examining structures from the gray matter cortex of the brain's lateral surface, including U fibers, long association fiber tracts, and the insular lobe, extending to the level of the internal capsule.</p><p><strong>Conclusions: </strong>Understanding the anatomical structures of white matter fiber tracts and vascular structures from the brain's lateral surface to the level of the internal capsule aids in planning safe, effective, and minimally invasive surgical procedures. It also contributes to advancements in neuroscience research.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248341","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":"Development and validation of a predictive model for poor initial outcomes after Gamma Knife radiosurgery for trigeminal neuralgia: a prognostic correlative analysis.","authors":"Sen Wang, Guanqi Chen, Jingwei Xie, Ruyi Yang, Xinjun Wang, Qiao Shan, Wanqing Liu, Dexiao Zhao, Fei Wang, Keke Li, Qingzhu Zhang, Yongkun Guo","doi":"10.3171/2025.2.JNS242655","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242655","url":null,"abstract":"<p><strong>Objective: </strong>The present study aimed to develop a reliable predictive model for identifying preoperative predictors of poor initial outcomes in patients with primary trigeminal neuralgia (PTN) treated with Gamma Knife radiosurgery (GKRS) and further elucidate the clinical significance of these predictors in initial outcomes and long-term pain recurrence.</p><p><strong>Methods: </strong>A total of 217 PTN patients were divided into a training set (n = 167) and a validation set (n = 50). The initial outcomes of GKRS treatment were assessed based on the Barrow Neurological Institute pain intensity scale. A predictive model was developed through multivariate regression and validated with repeated sampling. The differences in predictors of long-term pain recurrence were assessed using Kaplan-Meier analysis. The association between predictors was tested using chi-square tests, and subgroup analyses were performed to compare initial outcomes and long-term pain recurrence between two clinically significant correlates.</p><p><strong>Results: </strong>The training and validation sets showed areas under the curve of 0.85 and 0.88, respectively. Calibration curves and decision curve analysis indicated significant clinical benefits in both sets. Independent risk factors for poor initial outcomes included hyperglycemia, absence of neurovascular contact, carbamazepine insensitivity, and atypical pain (trigeminal neuralgia type 2 [TN2]). Carbamazepine insensitivity was moderately associated with TN2 and predicted long-term pain recurrence. Patients with both phenotypes had significantly worse initial outcomes compared with other subgroups (adjusted p = 0.0125).</p><p><strong>Conclusions: </strong>Patients with both TN2 and carbamazepine insensitivity have the poorest initial treatment outcomes and face an increased risk of recurrence. Furthermore, this predictive model is highly accurate and useful, offering a comprehensive method of identifying PTN patients likely to experience poor initial outcomes based on clinical characteristics and imaging perspectives. The authors believe that the nomogram presented in this model enables clinicians to calculate multiple variables and predict the probability of adverse events.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187189","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":"Extended lumbar drain trials for diagnostic evaluation of idiopathic normal pressure hydrocephalus with the Berg Balance Scale.","authors":"Nishanth S Sadagopan, Rushmin Khazanchi, Ethan J Houskamp, Khizar R Nandoliya, Rahul K Chaliparambil, Sachin Govind, Amr Alwakeal, Hui Zhang, Daniella Cannone, Jenna Grivas, Samantha Kennedy, Joshua M Rosenow, Maciej S Lesniak, James P Chandler, Matthew B Potts, Matthew C Tate, Stephen T Magill","doi":"10.3171/2025.1.JNS242354","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242354","url":null,"abstract":"<p><strong>Objective: </strong>Idiopathic normal pressure hydrocephalus (iNPH) is characterized by impaired gait, cognitive impairment, and urinary incontinence. Idiopathic NPH is treated with insertion of a ventriculoperitoneal shunt (VPS), but response to VPS placement varies. Extended lumbar drain (ELD) trials over a 3-day period can predict VPS success. Patients undergoing ELD trials are evaluated for gait improvement after lumbar drain (LD) placement using the Berg Balance Scale (BBS). This study examines changes in BBS scores in iNPH patients undergoing an ELD trial to determine the optimal trial length.</p><p><strong>Methods: </strong>This single-center, retrospective analysis included iNPH patients from 2007 to 2023 who underwent an ELD trial. Daily BBS scores were compared along with frequency of achieving the minimal detectable change (MDC), the threshold for clinical improvement, which varies between 4 and 7 points depending on the baseline score. Billing data were used to calculate the average daily charges of admission for ELD trials, excluding the LD procedure cost.</p><p><strong>Results: </strong>Eighty iNPH patients were included. The mean BBS score difference from baseline improved by 3.7 points on day 1, 7.19 points on day 2, and 8.38 points on day 3. MDC thresholds were met by 31% of patients on day 1, 77% on day 2, and 82% on day 3. The increase in MDC achievement from day 1 to day 2 was significant (p < 0.0001), while the change from day 2 to day 3 was not (p = 0.3428). The average total admission charge was $31,168.14 (standard error of the mean $994.61), with a per diem charge of $9756.05 after subtracting the LD procedure charge ($1900).</p><p><strong>Conclusions: </strong>While daily improvements in BBS score are seen during the ELD trial, achievement of MDC thresholds primarily happens by day 2. These data suggest that for patients who meet the MDC, limiting the ELD trial to 2 days could reduce costs without compromising the diagnostic utility of the ELD.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187190","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":"Outcome comparison between interposition and \"contactless\" transposition microvascular decompression approaches for trigeminal neuralgia.","authors":"Anthony T Lee, Ramin A Morshed, Sravani Kondapavulur, David J Caldwell, Noah Nichols, Genevieve Smith, Albert Wang, Mariann Ward, Maggie W Waung, Ethan Winkler, Edward F Chang","doi":"10.3171/2025.2.JNS241831","DOIUrl":"https://doi.org/10.3171/2025.2.JNS241831","url":null,"abstract":"<p><strong>Objective: </strong>Microvascular decompression (MVD) is an effective method of treating trigeminal neuralgia (TN). The traditional approach is an interposition technique in which Teflon is placed between the nerve and offending vessel. However, recurrent TN pain has been attributed to the Teflon itself, its migration, inflammatory granuloma formation, or continued direct compression. Thus, transposition techniques in which the nerve is fully decompressed without any contact with the offending vessel or the Teflon have been described. In this study, the authors report their institutional experience with interposition and newer transposition techniques such as sling transposition.</p><p><strong>Methods: </strong>A retrospective chart review was performed on patients who had undergone MVD from July 2015 to March 2024. Demographic, surgical, and clinical variables were collected, including modified Barrow Neurological Institute (BNI) pain intensity scale scores. Clinical outcomes were assessed using univariate and multivariate regression, and propensity score matching (PSM) was employed to minimize inherent heterogeneity in the surgical cohorts.</p><p><strong>Results: </strong>Three hundred five patients underwent MVD for TN. Eighty-four patients underwent interposition; 139, transposition with Teflon (full decompression with no contact to the nerve); and 48, transposition using a pericranium sling to the tentorium. A subset of these patients underwent concurrent rhizotomy: 73% interposition cases, 15% Teflon transposition cases, 4% sling transposition cases. Rhizotomy alone was performed in 34 patients. Transposition primarily involved the superior cerebellar artery (90%) and was associated with severe compression and nerve indentation. There were no differences in BNI scores at the last follow-up or in complications among the treatment groups. The only significant predictor of pain freedom on multivariate analysis was MRI demonstrating clear compression (OR 2.49, 95% CI 1.147-5.404, p = 0.021). However, subgroup analyses of patients with at least 1 year of follow-up showed a trend for increased pain freedom (BNI scores I and IIIa) with the sling transposition technique at 1 year, which was statistically significant at the 2-year follow-up (1 year: sling 96.6%, Teflon 86.9%, interposition 81.1%, p = 0.053; 2 years: sling 100%, Teflon 87.5%, interposition 77.5%, p = 0.049). PSM cohort analysis showed that sling transposition patients had higher rates of pain-free outcomes (BNI scores I and IIIa) at the last follow-up than the Teflon transposition patients (93.1% vs 62.1%, respectively, p = 0.003).</p><p><strong>Conclusions: </strong>Interposition and transposition techniques for MVD are both effective. The authors' midterm data suggest longer-term TN pain control with sling transposition. Further studies will need to confirm the durability of long-term pain freedom.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187193","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":"Hypofractionated radiosurgery for intracranial arteriovenous malformations: a systematic review and meta-analysis.","authors":"Vinay Jaikumar, Kyungduk Rho, Nicole Nobrega, Ali Haider, Hannah Danziger, Jaims Lim, Muhammad Waqas, Andre Monteiro, Pui Man Rosalind Lai, Jason M Davies, Kenneth V Snyder, Elad I Levy, Dheerendra Prasad, Adnan H Siddiqui","doi":"10.3171/2025.2.JNS242169","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242169","url":null,"abstract":"<p><strong>Objective: </strong>Obliteration of intracranial arteriovenous malformations (AVMs) with radiosurgery is challenging because high radiation doses prescribed for better effectiveness can increase procedural risks. To minimize adverse effects, fractionation protocols ensure delivery of equivalent or higher total radiation in manageable doses. Hypofractionated stereotactic radiosurgery (HF-SRS), a fractionation strategy using doses exceeding 2 Gy per fraction, requires fewer treatment sessions. The authors conducted a systematic literature review to meta-analyze potential benefits of HF-SRS compared with conventional fractionation regimens.</p><p><strong>Methods: </strong>PubMed and Embase were searched for literature on \"hypofractionated,\" \"radiosurgery,\" and \"arteriovenous malformations.\" Data including patient and AVM characteristics, procedural details, and outcomes were extracted from eligible studies. Meta-analyses were performed on variables reported by ≥ 3 studies. Subgroup analyses were conducted for photon- and proton-based HF-SRS.</p><p><strong>Results: </strong>The authors included 29 studies comprising 995 patients. For HF-SRS, digital subtraction angiography (DSA) confirmed a 50.1% obliteration rate (95% CI 35.2%-64.9%, I2 = 85.3%) at 41.2 months (95% CI 35.3-48.1 months, I2 = 95%) of follow-up, with an associated 11.1% (95% CI 8.4%-14.5%, I2 = 28.5%) rupture rate, 5.5% (95% CI 3.5%-8.5%, I2 = 0%) new-onset seizure rate, 10.4% (95% CI 6.8%-15.6%, I2 = 41.7%) radionecrosis, and 6% (95% CI 4%-8.9%, I2 = 13.7%) AVM-related mortality. Studies comparing total HF-SRS doses ≥ 35 Gy with < 35 Gy demonstrated trends toward higher rates of DSA-confirmed obliteration (60.9% vs 47.8%, p = 0.57) and radionecrosis (19.9% vs 8.2%, p = 0.02) with higher doses. Similarly, per-fraction doses ≥ 7 Gy showed higher obliteration trends (53.5% vs 44.5%, p = 0.64) and radionecrosis rates (18% vs 6.2%, p = 0.01) compared with < 7-Gy/fraction doses, indicating a dose-response relationship. Photon-based and proton-based HF-SRS resulted in comparable rates of angiographic obliteration (50.7% vs 48%, p = 0.86), follow-up rupture (10.3% vs 9.6%, p = 0.9), and AVM-related mortality (5.4% vs 7.4%, p = 0.5), despite a greater proportion of higher Spetzler-Martin grade AVMs in the photon-based studies (82.2% vs 55.3%, p < 0.01) with lower doses per fraction (7.2 vs 11.1 Gy, p < 0.01).</p><p><strong>Conclusions: </strong>HF-SRS is a promising radiosurgical strategy for AVMs with no statistically significant differences in effectiveness and adverse effects between photon- or proton-based therapies. There is notable heterogeneity in the application of HF-SRS for AVMs, necessitating further investigations with consistent reporting and incorporation of prior, adjuvant, and salvage treatments for AVMs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187192","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":"History and current state of neurosurgery in Greece.","authors":"Adamantios Kalogeras, Theodosios Spiliotopoulos, Nathan A Shlobin, Anastasia Tasiou, George A Alexiou, Nikolaos Foroglou, Moschos Fratzoglou, Theofilos S Paleologos, Vasilios Panagiotopoulos, Ioannis Patsalas, Aristeidis Prassas, George Stranjalis, Parmenion P Tsitsopoulos, Konstantinos Vlachos, Spyridon Voulgaris, Gail Rosseau, Kostas N Fountas","doi":"10.3171/2025.2.JNS242902","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242902","url":null,"abstract":"<p><p>There is a global deficit in access to neurosurgical care. Although most of the deficit occurs in low- and middle-income countries, high-income countries can also face similar problems. Greece has experienced challenges in the provision of neurosurgical care due to diverse terrains, socioeconomic inequalities, and deficient health systems. Discussions with key individuals involved in neurosurgical care were conducted to characterize the history and current state of neurosurgery in Greece. Data were collected from Greek hospitals with neurosurgical services and the archives of the Hellenic Neurosurgical Society. A summary of the background of Greece is provided. Then, the ancient and modern history of neurosurgery and the current state of neurosurgery in Greece is described, underscoring important moments and individuals in Greek neurosurgery. This article describes the history and current state of neurosurgery in Greece and yields critical insights to guide the neurosurgical community in developing neurosurgical care in countries that experience similar challenges as Greece.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187191","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":"Conservative management of 661 patients with unruptured intracranial aneurysms: an observational study over 4 decades.","authors":"Philippe Dodier, Philip Lederer, Bernhard Ecker, Muhammet Dogan, Elisabeth Strasser, Anna Cho, Dorian Hirschmann, Wei-Te Wang, Christian Dorfer, Lukas Haider, Arthur Hosmann, Andreas Gruber, Gerhard Bavinzski, Karl Rössler, Josa M Frischer","doi":"10.3171/2025.1.JNS241986","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241986","url":null,"abstract":"<p><strong>Objective: </strong>The management of unruptured intracranial aneurysms (UIAs) remains controversial, with a scarcity of long-term natural history data on conservative management. Therefore, the authors attempted to identify risk factors for aneurysm rupture in a cohort of consecutive patients with UIAs.</p><p><strong>Methods: </strong>In this retrospective observational study, the authors analyzed 661 patients with 767 exclusively UIAs who were conservatively managed at their tertiary referral center between 1984 and 2020. Patient-specific and aneurysm-specific risk factors for hemorrhage and aneurysm-related death were analyzed, including thresholds for the PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, and site of aneurysm) and ELAPSS (earlier subarachnoid hemorrhage, aneurysm location, age, population, aneurysm size and shape) scores that were set at 8 and 15, respectively, prior to the analyses.</p><p><strong>Results: </strong>The median follow-up in the conservative observation period was 4.1 years, with 42% of the patients observed for ≥ 5 years. The overall aneurysm-related mortality rate was 4.4%. In 23 (3.5%) patients, aneurysm rupture was reported during the conservative observation period, resulting in an overall calculated annual hemorrhage rate of 0.6%. Notably, 87% of the hemorrhages occurred in the first 5 years after diagnosis, whereas no single rupture occurred after 10 years. Aneurysm size and PHASES and ELAPSS scores were independent predictors of hemorrhage. Among patients with a PHASES score < 8 or an ELAPSS score < 15, no aneurysm-related death or aneurysm rupture occurred.</p><p><strong>Conclusions: </strong>The identified PHASES and ELAPSS score thresholds may help identify high-risk patients with UIAs. Individual aneurysm rupture risks must be carefully weighed against center-specific treatment outcomes. For conservatively managed UIAs, lifelong regular follow-up is recommended and seems to be especially important in the first 10 years after diagnosis.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187188","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":"Outcome metrics for primary endoscopic endonasal surgery for low-risk patients with Cushing's disease: an evidence-based position statement from the Registry of Adenomas of the Pituitary and Related Disorders consortium.","authors":"Michael Karsy, Varun R Kshettry, James J Evans, Garni Barkhoudarian, Won Kim, Donato R Pacione, Paul A Gardner, Juan C Fernandez-Miranda, Carolina G Benjamin, Michael P Catalino, Gabriel Zada, Robert C Rennert, Julie M Silverstein, Kyle Wu, Jamie J Van Gompel, Michael R Chicoine, Andrew S Little","doi":"10.3171/2025.1.JNS241286","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241286","url":null,"abstract":"<p><strong>Objective: </strong>Reports of surgical outcomes for Cushing's disease are mostly limited to single-center experiences by expert surgeons. Therefore, no generalizable surgical outcome metrics for endoscopic endonasal Cushing's disease surgery are available for practitioners to guide quality-improvement efforts. This is potentially problematic, given the high morbidity and excess mortality observed in patients who do not achieve remission. This study proposes a bundle of evidence-based metrics for low-risk patients with Cushing's disease, for whom optimal outcomes would be expected, that focus on the cost efficiency of care and surgical outcomes from multicenter collaboration of US pituitary centers.</p><p><strong>Methods: </strong>The steering committee of the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) consortium proposed the metrics based on available data from 12 US pituitary centers. A benchmarking population of low-risk patients undergoing first-time surgery was identified. Patient characteristics and outcomes were aggregated and analyzed by a data coordinating center. Metrics were reported using 2 approaches.</p><p><strong>Results: </strong>A total of 431 patients from 12 centers who underwent primary endoscopic transsphenoidal surgery from January 1, 2006, to December 31, 2022, were included. There were 227 patients in the low-risk cohort (age < 70 years, BMI < 50, microadenoma, and Knosp grade 0-2). For the cost-efficiency metrics, the mean (SD) length of stay was 3.8 (4.8) midnights, and the percentage of patients readmitted was 11.1%. The rate of disposition to a skilled nursing facility was 2.2%. For surgical outcomes, the rate of postoperative CSF leakage was 1.3%, and the rate of 1-year sustained surgical remission was 81.2%. The rates of permanent and temporary arginine vasopressin deficiencies were 1.8% and 11.9%, respectively. The 75th percentile performance by center was 3.0 midnights for length of stay, 6.3% for 90-day unplanned readmission, < 1% for disposition to a skilled nursing facility, < 1% for CSF leakage, and 92.2% for 1-year sustained remission. The 75th percentile was < 1% for both permanent and temporary arginine vasopressin deficiencies.</p><p><strong>Conclusions: </strong>An evidence-based bundle of metrics in a Cushing's disease patient population at low risk who underwent first-time endoscopic pituitary surgery is proposed. Surgeons can use these metrics to assess and improve the quality of their clinical pathways.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187194","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 impact of perilesional heatsink structures on ablation volumes and symmetry in laser interstitial thermal therapy for the treatment of primary central nervous system tumors.","authors":"Chandler N Berke, Cameron A Rivera, Shovan Bhatia, David Levi, Adham M Khalafallah, Victor M Lu, Kate Stillman, Chase DeLong, Eric Singh, Adam Levy, Ashish H Shah, Ricardo J Komotar, Michael E Ivan","doi":"10.3171/2025.1.JNS241377","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241377","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment for primary CNS tumors. While LITT offers advantages over traditional approaches, perilesional intracranial heatsinks can lead to asymmetrical ablation, impacting patient outcomes. Understanding heatsink effects is crucial for optimizing LITT efficacy.</p><p><strong>Methods: </strong>The authors retrospectively analyzed primary CNS tumors treated with LITT at a single tertiary care center. Ablation outcomes were quantified using the Heatsink Effect Index (HEI), measured on a scale of 0-1 (0 = total symmetry, 1 = complete asymmetry), and extent of ablation (EOA). The heatsink types evaluated were sulci, meninges, vasculature, and CSF spaces, inclusive of ventricles, resection cavities, and CSF cisterns. Statistical analyses were performed to assess the relationship between heatsink proximity and type and ablation outcomes.</p><p><strong>Results: </strong>A total of 99 patients satisfied all selection criteria. The cohort was 53% female, with a mean age of 61 years. Glioblastoma was the most predominant tumor type (78%), followed by low-grade glioma (15%) and meningioma (4%). Heatsink proximity significantly correlated with ablation asymmetry (HEI) (p < 0.001), particularly at the midpoint of the catheter trajectory. The correlation between closest heatsink distance and HEI varied across the different heatsink types, with distance to vasculature and CSF spaces correlating the strongest with ablation asymmetry. When assessing the relationship between EOA and medial HEI during suboptimal ablations (EOA < 100%), a negative correlation was demonstrated, showing improved EOA as HEI was reduced. Optimal cutoff catheter-heatsink distances for predicting ablation asymmetry ranged from 6.6 to 13.0 mm, emphasizing the impact of heatsink proximity on LITT efficacy.</p><p><strong>Conclusions: </strong>This study shows that proximity to heatsinks, especially within a threshold distance of 13.0 mm from the laser catheter, significantly predicts ablation asymmetry and volume in the setting of primary CNS tumors. Vasculature and CSF spaces demonstrate the strongest heatsink effects. Neurosurgeons should consider heatsink effects in pre- and intraoperative planning to optimize LITT outcomes and preserve normal brain tissue.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132367","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":"Microsurgical management of 883 previously coiled intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of its effectiveness and safety.","authors":"Keng Siang Lee, Oliver Wroe-Wright, John J Y Zhang, Ahilan Kailaya-Vasan, Ramez Kirollos, Julian Han, Pascal Jabbour, Michael T Lawton","doi":"10.3171/2025.2.JNS242565","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242565","url":null,"abstract":"<p><strong>Objective: </strong>With the increasing number of intracranial aneurysms (IAs) treated by endovascular coiling, more residual and recurrent IAs are being encountered. This study aimed to evaluate the effectiveness and safety of the microsurgical management of these previously coiled IAs.</p><p><strong>Methods: </strong>Systematic searches of the Medline, Embase, and Cochrane Central databases were performed. The primary outcome was good functional outcome (modified Rankin Scale score 0-2 or Glasgow Outcome Scale score 4-5) and unchanged/improved functional outcomes at the last follow-up. Secondary outcomes included intraoperative rupture, complete occlusion confirmed on imaging, and perioperative complications and death within 30 days.</p><p><strong>Results: </strong>Thirty-nine studies reporting on 874 patients with 883 previously coiled IAs managed by microsurgery were included in the meta-analysis. Of the 883 IAs, 656 (74.3%), 167 (18.9%), 44 (5.0%), and 16 (1.8%) underwent direct clipping, clipping with coil removal, bypass, and trapping, respectively. Forty-five (5.1%), 806 (91.3%), and 32 (3.6%) IAs were classified as Gurian group A, B, and C. IAs were located anteriorly in 88.2% and posteriorly in 11.8%; 45.3% were < 7 mm, 31.3% were 7-12 mm, 14.6% were 13-24 mm, and 8.8% were > 25 mm. The overall mean clinical follow-up duration was 33.7 months. Overall proportions of intraoperative rupture, perioperative stroke, and death were 0.1% (95% CI 0.0%-1.1%, I2 = 25.2%), 8.2% (95% CI 5.85%-11.34%, I2 = 52.8%), and 3.7% (95% CI 2.63%-5.24%, I2 = 0.0%), respectively. The proportions of complete occlusion, good, and improved/unchanged functional outcomes were 97.2% (95% CI 95.82%-98.13%, I2 = 0.0%), 82.9% (95% CI 79.67%-85.69%, I2 = 5.1%), and 92.3% (95% CI 89.27%-94.54%, I2 = 0.0%), respectively. Direct clipping of unruptured anterior circulation IAs was associated with the lowest proportion of intraoperative rupture, perioperative stroke, and death. Direct clipping was also associated with the greatest proportion of complete occlusion, good functional outcome, and improved/unchanged neurological outcome. Microsurgery within 1 month of endovascular coiling and management of Gurian group C IAs were associated with greater proportions of perioperative death.</p><p><strong>Conclusions: </strong>Microsurgical management of previously coiled IAs is an effective and safe strategy in well-selected patients. Important factors to consider in the management of these IAs include the size and location of the IA, rupture status at initial presentation, indication for microsurgery, and type and timing of microsurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132452","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}