Journal of neurosurgery最新文献

{"title":"Institutional experience using the endoscopic endonasal approach for the treatment of 40 intracranial aneurysms: indications, outcomes, and technical considerations.","authors":"Maria Karampouga, Ali A Alattar, Bradley A Gross, Alhamza R Al-Bayati, Garret Choby, Eric W Wang, Carl H Snyderman, Paul A Gardner, Georgios A Zenonos","doi":"10.3171/2025.4.JNS242716","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242716","url":null,"abstract":"<p><strong>Objective: </strong>The endoscopic endonasal approach (EEA) provides a ventral surgical corridor, which can be advantageous in the management of carefully selected cerebral aneurysms. The literature lacks large series to better delineate the indications and limitations of this technique. The aim of this study was to elucidate the technique's safety, indications, advantages, and limitations, as well as its evolution over time.</p><p><strong>Methods: </strong>The clinical records of all patients with intracranial aneurysms treated via EEA at the authors' institution, from the unveiling of the technique in March 2005 to February 2025, were retrospectively reviewed. Patient-specific treatment indications, surgical results, and technical parameters were examined.</p><p><strong>Results: </strong>The study cohort consisted of 40 aneurysms in 34 patients. Six patients had 2 aneurysms clipped during the same endonasal procedure, while 3 others had a sellar tumor excised concurrently. Seven patients initially presented with subarachnoid hemorrhage, and 4 had pseudoaneurysms. Anatomically, 29 aneurysms were situated in the paraclinoid or cavernous sinus region, 10 were in the posterior circulation, and 1 giant aneurysm involved the petrous and cavernous internal carotid artery. Surgical treatment was only considered if endovascular therapy was not thought to be appropriate by experienced endovascular specialists. EEA was chosen if it was perceived to be safer than an open approach in terms of obtaining proximal and distal control, reducing manipulation of cranial nerves or the brain, or for the treatment of concomitant sellar pathology. Four patients underwent EEA for mass effect, 2 after postcoiling recanalization, and 3 because of antiplatelet contraindication/intolerance. Postoperative complications included 8 patients experiencing CSF leaks, 3 meningitis, 2 clip exposure, 3 lacunar infarcts (2 causing mild disability), and 4 new cranial nerve palsies that either improved or resolved. There were no parenchymal contusions, venous infarcts, postoperative seizures, optic neuropathies, lower cranial nerve palsies, or procedure-related mortalities. In the latter series of 14 cases since 2019, complications were mainly CSF leaks, with no long-term effects. During an average follow-up of 62.6 months, 1 patient required retreatment with a flow diverter.</p><p><strong>Conclusions: </strong>The ventral surgical corridor afforded by EEA is a valuable option for the surgical treatment of carefully selected paraclinoid internal carotid artery and posterior circulation aneurysms arising medial to the cranial nerves, particularly when endovascular options are restricted. EEA may result in decreased morbidity related to cranial nerve deficits and parenchymal injury compared with lateral approaches. However, CSF leaks remain the main limitation, especially after subarachnoid hemorrhage.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957462","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. Findings of ISAT versus ISAT-2: indications for endovascular treatment of ruptured aneurysms.","authors":"Andrew Molyneux, Richard Kerr","doi":"10.3171/2025.5.JNS25971","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25971","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957525","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":"Intratumoral heterogeneity correlated with the extent of resection as a critical factor for postoperative management of low-grade gliomas with malignant foci.","authors":"Hugues Duffau","doi":"10.3171/2025.5.JNS25324","DOIUrl":"https://doi.org/10.3171/2025.5.JNS25324","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":3.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957527","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":"Long-term follow-up outcomes in intracranial solitary fibrous tumor compared with meningioma: a propensity score matching study.","authors":"Leihao Ren, Jiaojiao Deng, Ao Feng, Tareq A Juratli, Lingyang Hua, Hiroaki Wakimoto, Qing Xie, Ye Gong","doi":"10.3171/2025.4.JNS242400","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242400","url":null,"abstract":"<p><strong>Objective: </strong>Intracranial solitary fibrous tumor (ISFT) is a rare type of neoplasm that resembles meningioma. The authors aimed to compare the long-term postoperative outcomes between patients with ISFT and those with meningioma, and to create a model to identify patients with ISFT who are at high risk of recurrence.</p><p><strong>Methods: </strong>A total of 187 patients with de novo ISFT and 473 patients with de novo meningioma who underwent tumor resection at a single neurosurgical center from 2013 to 2021 were included in this study. Cohorts were matched using propensity score matching (PSM). Univariate and multivariate Cox regression analyses were performed to evaluate prognostic values of clinicopathological characteristics.</p><p><strong>Results: </strong>The ISFT cohort was comprised of 187 patients (106 male, mean age 46.6 years) and, after PSM, the meningioma cohort was comprised of 187 patients (95 male, mean age 49.2 years) for comparison. The survival analysis showed that the ISFT cohort had significantly worse progression-free survival (PFS) after 5 years of follow-up (p < 0.0001) compared with the meningioma cohort. No significant difference in disease-specific survival (DSS) was observed between the cohorts during the first 5 years. However, beyond 5 years, the ISFT cohort had significantly worse DSS than the meningioma cohort (p = 0.025). Further analysis of prognostic factors revealed that an age at diagnosis ≤ 57 years, Ki-67 index ≤ 6%, mitotic count ≤ 15, low WHO grade, and receiving postoperative radiation therapy (RT) were significantly associated with prolonged PFS. Moreover, age at diagnosis, mitotic count, and postoperative RT were identified as independent factors for predicting PFS. Finally, a prognostic model was constructed to identify patients with ISFT at high risk of recurrence. The model demonstrated excellent predictive performance, particularly for predicting PFS beyond 5 years after surgery.</p><p><strong>Conclusions: </strong>The long-term prognosis of patients with ISFT was significantly worse compared with that of patients with meningioma after surgery, and this was impacted by age at diagnosis, mitotic count, and undergoing postoperative RT. The prognostic model showed excellent predictive performance for identifying patients with ISFT at high risk of recurrence.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957624","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":"Experience and safety of intraoperative Neuropixels: a case series of 56 patients.","authors":"Jason E Chung, Duo Xu, Quinn R Greicius, Tanay Poddar, Matthew K Leonard, Kristin K Sellers, John P Andrews, Marleen Welkenhuysen, Barundeb Dutta, Cathryn R Cadwell, Edward F Chang","doi":"10.3171/2025.4.JNS241162","DOIUrl":"10.3171/2025.4.JNS241162","url":null,"abstract":"<p><strong>Objective: </strong>The Neuropixels probe, a high-density silicon microelectrode array, has been a transformative tool for extracellular recording of large numbers of single neurons across animal models. Traditional tungsten microelectrodes available for clinical neurophysiology typically only record 1-2 neurons at a given time. Human intraoperative Neuropixels recording increases access to single-neuron spiking by an order of magnitude and is poised for rapid adoption. The authors' objective was to determine the safety and yield of intraoperative Neuropixels for large-scale simultaneous neuronal recordings.</p><p><strong>Methods: </strong>This study examined safety and the success rate from the authors' case series of 56 consecutive patients who participated in Neuropixels intraoperative recording at the authors' institution. All participants were undergoing craniotomy for resection for various pathologies (intractable epilepsy [n = 33], tumor [n = 19], and vascular lesion [n = 4]). Among these craniotomies for resection, the vast majority were done under monitored anesthesia care with awake mapping (50/56). In all cases, a Neuropixels probe was placed into tissue that was resected, allowing histology to be recovered from a subset of cases. All intraoperative probe fractures, cases that did not yield any putative single-neuron recordings, and postoperative complications are reported here.</p><p><strong>Results: </strong>No medical or neurological complications, surgical complications, 30-day readmissions, or deaths were observed. Overall, probe fractures were rare (n = 3) and all occurred within the first 6 cases. All fractures occurred at the base of the probe shank and were easily recovered. In recovered acute histology from 1 case, the histological evidence of insertion was minimal and proportional to the 70 mm × 132 mm cross-sectional area. In terms of yield, most cases had good neuronal yield, with only 9 (16.1%) cases that did not result in at least 1 putative single-neuron recording, with the etiology of failure being attributable to either electrical noise (6/9) or there being no detectable spikes (3/9). All cases that did not result in at least 1 putative single-neuron recording occurred within the first 20 cases, suggesting significant improvements in the learning curve and techniques for high-yield and safe intraoperative recordings.</p><p><strong>Conclusions: </strong>Intraoperative Neuropixels recordings can be done safely for large-scale neuronal recordings. Over time, the authors experienced no probe fractures and improved success rate of microelectrode recording. Further measures to float the electrodes, limit forces on the probe, and prevent probe fracture during insertion may improve the yield. Neuropixels has tremendous potential for future applications in clinical functional mapping over traditional microelectrodes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957424","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":"Advanced MRI of calcified carotid artery plaques: pathological validation of accuracy.","authors":"Tomotaka Ishizaki, Shuya Kurono, Masahiro Nakano, Kentaro Fujii, Otone Endo, Takeshi Okada","doi":"10.3171/2025.4.JNS241803","DOIUrl":"https://doi.org/10.3171/2025.4.JNS241803","url":null,"abstract":"<p><strong>Objective: </strong>Carotid artery atherosclerotic plaques undergo various pathological changes during disease progression, and their characterization relies on MRI, CT, and ultrasound imaging. The diagnosis of calcified lesions using only MRI is challenging because of irregular low-signal areas across all sequences. Conventionally, a diagnosis is made by combining multiple modalities such as contrast-enhanced CT (CECT) and carotid ultrasonography. Field echo resembling CT using restricted echo-spacing (FRACTURE) is a new MRI sequence with enhanced bone contrast that uses a 3D gradient echo pulse sequence. The aim of this study was to evaluate the ability of FRACTURE to detect carotid plaque calcification by comparing its images with pathological findings from carotid endarterectomy (CEA). The study also compared the accuracy of conventional CECT and MRI plaque imaging with that of FRACTURE and assessed its accuracy in stenosis rate evaluation using fusion imaging with MR angiography (MRA).</p><p><strong>Methods: </strong>This retrospective analysis included 21 consecutive patients (average age 74 years, 16 males) who underwent FRACTURE, CECT, and MRA (including time-of-flight and black-blood techniques) as preoperative examinations for CEA. Pathological specimens from extracted plaques were analyzed, and the calcified areas were measured and statistically compared across imaging modalities. Digital subtraction angiography (DSA) was used as the reference standard for stenosis rate evaluation.</p><p><strong>Results: </strong>The sensitivity and specificity of FRACTURE in detecting calcified lesions in pathological specimens were comparable with those of CECT (sensitivity 91.7% vs 95.8%, specificity 96.6% vs 93.1%) and superior to those of MRA (sensitivity 75.0%, specificity 93.1%). Furthermore, for lesions < 2 mm2, significant differences in the measured calcified areas were observed between pathological specimens and both CECT and MRA, whereas no significant difference was found with FRACTURE, suggesting its superiority for small lesions. In stenosis rate assessment, no significant differences were found among FRACTURE/MRA, CECT, and DSA in overall stenosis measurements. However, in cases in which calcified lesions directly faced the vascular lumen, CECT tended to overestimate stenosis because of beam-hardening artifacts, while FRACTURE/MRA showed a higher agreement with DSA, indicating greater accuracy.</p><p><strong>Conclusions: </strong>FRACTURE is a useful MRI sequence with higher sensitivity and specificity than those of MRA and accuracy comparable with that of CECT for calcified lesion detection. Additionally, it may provide superior detection of small, calcified lesions and more accurate stenosis assessment in cases with calcified plaques.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957843","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 signaling on interview invitations in the neurological surgery match process.","authors":"Melanie Alfonzo Horowitz, Albert Antar, James Feghali, Carly Weber-Levine, Shahab Aldin Sattari, Risheng Xu, Daniel Lubelski, Timothy F Witham, Debraj Mukherjee, Mari Groves, Henry Brem, Judy Huang","doi":"10.3171/2025.4.JNS25227","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25227","url":null,"abstract":"<p><strong>Objective: </strong>Neurosurgery remains one of the most competitive residency programs with an increasing application volume. Signaling was introduced to allow applicants to express interest in specific programs and streamline program director application review; however, there are limited data on how signaling affects interview invitations in neurosurgery. This study investigates the impact of signaling on interview invitation odds and subsequent residency program selection.</p><p><strong>Methods: </strong>The authors analyzed data from 93 Accreditation Council for Graduate Medical Education-accredited neurosurgery residency programs from the 2024 application cycle, sourced from the Residency Explorer platform. A signal strength index (SSI) was created using two metrics: odds ratio (OR) of receiving an invitation to interview for signaling and nonsignaling applicants and absolute difference in interview rates between these applicant groups. Correlations among SSI, Doximity program rankings, and program location were also examined. Statistical significance was set at an α of 0.05.</p><p><strong>Results: </strong>Signaling a program significantly influenced interview invitations, with 19 programs (20.4%) inviting only applicants who signaled their institution and 65 programs (69.9%) inviting < 10% of applicants who did not signal the program. Doximity program rankings were weakly correlated with the SSI (Pearson's r = 0.26, p = 0.01) and moderately correlated with a program's OR rank (Pearson's r = 0.44, p < 0.01). After controlling for Doximity rank, program size was negatively correlated with the OR rank (Pearson's r = -0.26, p = 0.01). The geographic location of a program did not correlate with the SSI (p = 0.48).</p><p><strong>Conclusions: </strong>Signaling plays a key role in neurosurgery residency interview invitations, with its impact varying across programs based on factors like program rank and competitiveness. The SSI represents a comprehensive tool for applicants to assess which programs to signal, optimizing their chances of receiving an offer to interview.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957396","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":"Takanori Fukushima 1942-2024.","authors":"William T Couldwell, Ali Zomorodi, Allan Friedman","doi":"10.3171/2025.4.JNS2550","DOIUrl":"https://doi.org/10.3171/2025.4.JNS2550","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957645","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. Neurosurgical training in rural and remote regions.","authors":"Elena Olgiati, Salvatore Chibbaro, Ismail Zaed","doi":"10.3171/2025.4.JNS25989","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25989","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957535","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":"Reduced risk of reoperation of chronic subdural hematoma in patients treated with active subgaleal drainage compared with passive subdural drainage.","authors":"Irena Grubor, Bryndís Baldvinsdóttir, Murtadha Al-Hesnawi, Henrietta Nittby Redebrandt","doi":"10.3171/2025.4.JNS242409","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242409","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (CSDH) is a common cause of morbidity in the older population and the incidence of CSDH is likely to increase in upcoming years due to the increasing age of the population. Surgical intervention is the cornerstone of treatment, but trials have shown conflicting results regarding the optimal type of surgical drainage. The aim of this study was to compare outcomes between patients with CSDH who were surgically treated with active subgaleal drainage versus passive subdural drainage.</p><p><strong>Methods: </strong>This retrospective single-center cohort study included patients who underwent surgery for CSDH from 2020 to 2022. In a neurosurgical department in Lund, Sweden, the clinical routine changed from use of a passive subdural drain to an active subgaleal drain during this period. Data were collected from patient medical records and analyzed using univariable analysis followed by multivariable logistic regression analysis. The primary outcome was reoperation for recurrent hematoma within 3 months. Secondary outcomes were postoperative morbidity and mortality.</p><p><strong>Results: </strong>Of 452 patients (331 male, median age 78 years) included in the analysis, 3 were lost to follow-up, leaving 230 patients who received passive subdural drainage and 219 patients who received active subgaleal drainage for outcomes assessment. The risk of recurrent surgery for CSDH within 3 months was significantly lower in the active subgaleal drain group (12.7%) compared with the passive subdural drain group (20.1%) (p = 0.022). Regarding secondary outcomes, no statistically significant differences were found.</p><p><strong>Conclusions: </strong>Risk of recurrent CSDH requiring surgery was lower in patients who received active subgaleal drainage compared with those who received passive subdural drainage, with no increased risk of postoperative complications. These findings support use of the active subgaleal drain system for CSDH surgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859284","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}