Journal of neurosurgery最新文献

{"title":"Letter to the Editor. Pharmacotherapeutic advances refine MMAE demand projections for cSDH.","authors":"Kaiqin Chen, Rui Cheng, Shangming Zhang","doi":"10.3171/2026.4.JNS26617","DOIUrl":"https://doi.org/10.3171/2026.4.JNS26617","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891972","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. Methodological considerations in interpreting long-term outcomes of poor-grade aSAH.","authors":"Ferhat Can","doi":"10.3171/2026.5.JNS26990","DOIUrl":"https://doi.org/10.3171/2026.5.JNS26990","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891996","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":"M. Gazi Yaşargil (1925-2025): a comprehensive bibliometric analysis of his impact on modern microneurosurgery.","authors":"Ali Hammed, Bilal Younes, Thomas Reithmeier, Numier Alyosef, Michael T Lawton, Atta Ul Aleem Bhatti, Steffen K Rosahl, Andreas K Demetriades, Daniel Walsh","doi":"10.3171/2026.3.JNS252702","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252702","url":null,"abstract":"<p><p>M. Gazi Yaşargil, often called the \"father of modern microneurosurgery,\" fundamentally reshaped neurosurgery through a philosophy emphasizing precision and functional preservation. Despite his widely acknowledged legacy, no comprehensive, data-driven analysis has consolidated the full scope of his clinical and scholarly impact. This study combines a narrative synthesis of Yaşargil's work with a bibliometric meta-analysis of his publications from 1952 to 2024, evaluating contributions across anatomical approaches, technical innovations, therapeutic strategies, surgical outcomes, and academic influence. Findings highlight foundational anatomical approaches, such as the pterional craniotomy, and key technical innovations, including specialized microsurgical instruments. His therapeutic strategies achieved durable outcomes, with > 90% obliteration rates in selected vascular cohorts and Engel class I seizure freedom in approximately 70% of epilepsy cases. Bibliometric analysis of 145 publications (approximately 15,089 citations) shows his sustained scholarly influence, with 2748 citations accrued since 2020, particularly in epilepsy and tumor research. This work underscores Yaşargil's enduring impact: anatomy-driven, transferable strategies that remain central to contemporary neurosurgical practice, even amid advances in robotics, endovascular techniques, and image guidance.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892009","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":"Probabilistic tractography of the optic radiation to improve prediction of visual outcomes following temporal lobe epilepsy surgery: an international multicenter study.","authors":"Samuel Wreghitt, Jian Chen, Alexandra Roche, Timothy Williamson, Philip Pruckner, Kurt Schilling, Andrew Neal, Joshua Laing, Terence J O'Brien, Dario J Englot, Victoria L Morgan, Matthew J Gutman, Joseph Yuan-Mou Yang","doi":"10.3171/2026.3.JNS252520","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252520","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Postoperative visual field deficits (VFDs) following anterior temporal epilepsy surgery often result from Meyer's loop (ML) injury. Optic radiation (OR) tractography aids surgical planning, but accuracy varies by method. Deterministic diffusion tensor imaging (Det-DTI) tractography underrepresents fiber complexity, whereas constrained spherical deconvolution with probabilistic tracking (Prob-CSD) resolves crossing fibers and improves anatomical fidelity. The aim of this study was to compare Det-DTI and Prob-CSD for OR/ML delineation and to evaluate accuracy by correlating tract injury with postoperative VFD severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Adults who underwent anterior temporal epilepsy surgery at two centers (Alfred Hospital in Melbourne, Australia; Vanderbilt University Medical Center in Nashville, Tennessee, US) were included. All patients underwent pre- and postoperative T1-weighted and diffusion-weighted MRI and automated postoperative perimetry. Det-DTI and Prob-CSD tractography pipelines, using the same expert-guided regions of interest, were compared. Tract injury was quantified as volumetric overlap between reconstructed ORs and resection cavities. VFD severity was measured as quadrant-specific visual field (QsVF) scores from perimetry. Reconstructed tract and estimated injury volumes were compared using the Wilcoxon signed-rank test, and their correlations with QsVF were assessed using Pearson correlation. Linear regression was used to assess whether Prob-CSD-estimated tract injury independently predicted postoperative QsVF, with resection volume and surgical technique as covariates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 33 patients (19 female, median age 39.1 years; 30 right handed and 11 left sided) were included in the analysis. Surgery comprised 9 anterior temporal lobectomies, 21 selective amygdalohippocampectomies, and 3 lesionectomies. Compared with Det-DTI, Prob-CSD tractography delineated significantly larger OR volumes (mean 20.18 ± 4.76 cm3 vs 1.48 ± 1.05 cm3; p = 8.34 ×10-7) and identified greater tract injury volumes (mean 0.60 ± 0.81 cm3 vs 0.04 ± 0.16 cm3; p = 3.7 ×10-6). Det-DTI failed to reconstruct ML in all but one case. Prob-CSD tract injury volumes correlated strongly with postoperative QsVF scores (r = -0.63, p = 7.35 ×10-5), whereas Det-DTI showed a weaker nonsignificant association (r = -0.31, p = 0.08). Linear regression confirmed independent association between Prob-CSD tract injury and postoperative VFD severity (p = 0.002, SE = 7.23 ×10-5, adjusted R2 = 0.34).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Prob-CSD tractography outperformed Det-DTI in reconstructing ML and reliably predicting postoperative VFDs, regardless of surgical technique and resection extent. Det-DTI should be avoided for ML tractography. This study strongly supports incorporating expert-guided Prob-CSD into preoperative planning to enhance patient counseling and reduce risk of visual morbidity following","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892038","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":"Refining the posterior compartment of the cavernous sinus: a detailed reappraisal of surgical anatomy and techniques for invasive pituitary adenoma resection.","authors":"Yuanzhi Xu, Tatsuya Uchida, Erik Burgos-Sosa, Ana Sofia Alvarez, Mariano Rinaldi, Taishi Nakase, Matei Alexandru Banu, Ludovico Agostini, Limin Xiao, Vera Vigo, Peyton L Nisson, Simon A Menaker, Aaron A Cohen-Gadol, Juan C Fernandez-Miranda","doi":"10.3171/2026.4.JNS252898","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252898","url":null,"abstract":"<p><strong>Objective: </strong>Access to the posterior compartment of the cavernous sinus (CS) remains one of the greatest challenges via endoscopic endonasal surgery because of its deep location behind the posterior genu of the internal carotid artery (ICA) and the complex neurovascular ligamentous structures it contains. To date, no comprehensive anatomical study has focused specifically on the posterior compartment of the CS from the perspective of an endoscopic endonasal approach (EEA). The aim of this study was to delineate the microsurgical anatomy and technical nuances critical for safely accessing this compartment via the EEA.</p><p><strong>Methods: </strong>Thirty-nine colored silicone-injected cadaveric heads were dissected, 19 via a transcranial approach and 20 via an EEA. Two illustrative surgical cases were also reviewed to highlight anatomical landmarks and strategies for tumor resection within the posterior compartment of the CS.</p><p><strong>Results: </strong>The posterior compartment exhibited a triangular configuration in 66.7% of hemispheres and a quadrilateral shape in 33.3%, depending on the angulation of the ICA posterior genu. The posterior parasellar ligament was present in 64% of hemispheres, with 42% displaying a two-anchor configuration and 58% a net-like morphology. The posterior petroclinoid ligament, a dural fold marking the transition from the roof to the posterior wall of the CS, showed a smooth slope in 76% and ossification at attachment sites in 69%. Gruber's ligament, a periosteal dural extension from the posterior clinoid base to the petrous apex, appeared as a robust membranous band in 78% of hemispheres and as ossified in 59%. Potential spaces around Gruber's ligament may serve as key corridors for tumor invasion and remnants. Four venous outlets of the posterior compartment, draining into the basilar plexus, foramen lacerum plexus, inferior petrosal sinus, and superior petrosal sinus, were consistently identified.</p><p><strong>Conclusions: </strong>This study provides a systematic description of the posterior compartment of the CS from an EEA perspective, clarifying its ligamentous, arterial, and venous architecture and offering critical insights for safe and effective tumor resection.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850833","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 surgeon beyond his era: neurosurgical contributions of Eugène-Louis Doyen (1859-1916).","authors":"Ali Tayebi Meybodi, Thomas J On, Andre A Payman, Carlos E Calderon Valero, Oscar Alcantar-Garibay, Pooneh Mokhtari, Andrea L Castillo, Kivanc Yangi, Mark C Preul","doi":"10.3171/2026.4.JNS252504","DOIUrl":"https://doi.org/10.3171/2026.4.JNS252504","url":null,"abstract":"<p><p>Eugène-Louis Doyen studied medicine in Reims and Paris, further refining his surgical approach through experiences in Heidelberg, Würzburg, and Vienna. Recognized in French surgery for his innovations across thoracic, abdominal, and gynecological disciplines, his critical contributions to early neurosurgery, particularly trigeminal neuralgia treatment, remain significantly underexplored. Combining elements from the Hartley-Krause subtemporal route and the Rose sphenoidal route, he developed an advanced trigeminal ganglionectomy technique to minimize complications. Doyen introduced the electric craniotome, instruments specifically designed for dural detachment, and specialized devices to enable precise en bloc ganglion removal, thereby enhancing surgical safety and efficiency. He developed a minimally invasive retrosigmoid craniotomy approach using a speculum and custom neurotome to sever the sensory trigeminal root. This groundbreaking cerebellopontine angle endoscopy technique substantially reduced invasiveness compared to more extensive gasserectomy procedures. Despite the considerable controversy stemming from his abrasive personality, unorthodox methods, and provocative practices, such as filming surgical procedures, Doyen's bold innovations advanced neurosurgical techniques at the turn of the 20th century. Examining his career offers essential insights into a pivotal transitional era when ambitious operations on the brain began evolving into more precise, organized, and effective neurosurgical practices.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850783","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 discrete-time Markov pipeline model of neurosurgical workforce attrition and retention rates across Africa through 2030.","authors":"Ulrick Sidney Kanmounye, Claire Karekezi, Zak Farazi, Claudette Wilson, James Balogun, Teddy Totimeh","doi":"10.3171/2026.3.JNS252665","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252665","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to project the total neurosurgical workforce across African countries by 2030, quantify the impact of policy interventions, and assess capacity and infrastructure constraints on advanced subspecialization across the continent.</p><p><strong>Methods: </strong>The authors utilized a discrete-time Markov pipeline model to track prospective candidates from medical graduation through training and retention. Data were sourced from the World Federation of Neurosurgical Societies, WHO, and pan-African surveys for workforce counts, attrition rates, and training capacity. The equipment readiness index (ERI) was developed to link infrastructure to the feasibility of subspecialization practice. Projections were simulated under 4 scenarios, including a policy pack intervention (scholarships, mentorship, equipment), with uncertainty quantified via Monte Carlo methods. A fractional logit model assessed the policy pack's effect on the projected female share of the workforce.</p><p><strong>Results: </strong>The median baseline neurosurgeon count was 10 per country. Annually, at least 231 medical students express interest in neurosurgery; however, limited residency spots cause waiting lists to grow by approximately 154 applicants annually. ERI scores showed extreme variability; only Egypt (0.81) surpassed the highest subspecialization threshold, while 21 countries scored below 0.10, severely curtailing advanced practice feasibility if there is no intervention. Under the baseline scenario, the workforce is projected to reach 5888 by 2030 (43.1% increase). The policy pack scenario yielded 8809 neurosurgeons (a 49.6% increase over baseline). The policy pack positively impacted the female share (median OR 1.28, 95% CI 1.01-1.61; p = 0.04); however, higher ERI was not a significant predictor.</p><p><strong>Conclusions: </strong>The African neurosurgical workforce faces binding constraints from limited training capacity and poor infrastructure readiness. Targeted policy interventions can power equitable growth.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850869","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":"Voxel-based analysis of glioblastoma topography and invasiveness using the Brain-Grid system: a multicenter retrospective study.","authors":"Umberto Aldo Arcidiacono, Marta Bonada, Alessandro Falanga, Markus Fahlström, João M Sousa, Ekaterina Tomilina, Lorenzo Sala, Francesco DiMeco, Francesco Latini","doi":"10.3171/2026.3.JNS252145","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252145","url":null,"abstract":"<p><strong>Objective: </strong>Precise characterization of glioblastoma (GBM) location is essential for prognosis and surgical planning. The aim of this study was to evaluate whether voxel-based analysis with the Brain-Grid (BG) system can provide prognostic insights by quantifying tumor invasiveness and spatial distribution.</p><p><strong>Methods: </strong>The authors retrospectively analyzed 116 adult patients who underwent treatment for newly diagnosed IDH-wildtype GBM. Tumors were classified on preoperative MRI using the BG system. Clinical, radiological, and molecular variables, including MGMT promoter methylation, were correlated with overall survival (OS), progression-free survival, and functional outcomes.</p><p><strong>Results: </strong>The mean patient age was 63.5 ± 9.7 years. The mean OS was 14.4 ± 8.86 months (maximum 53 months). The mean number of infiltrated BG voxels was 5.8 ± 3.1 (median 5, IQR 3-8; maximum 14). Patients with ≥ 6 voxels had shorter OS (p = 0.012). Tumors most often involved the A2-C2-S2 and A2-C2-S3 voxels (where \"A\" indicates \"axial,\" \"C\" indicates \"coronal,\" and \"S\" indicates \"sagittal\"), corresponding to the basal ganglia and subventricular zone. Right-sided tumors were most common; posterior localization was associated with better survival (area under the curve = 0.71). Resection in the A2-C2-S3 voxel correlated with improved OS (p = 0.03). The median preoperative tumor volume was 38.74 cm3; higher pre- and postoperative volumes and lower extent of resection (EOR) predicted worse prognosis (p = 0.012, p = 0.001, and p = 0.002, respectively). MGMT methylation showed no significant correlation with OS (p = 0.15) or voxel distribution.</p><p><strong>Conclusions: </strong>Voxel-based analysis with the BG system enables quantitative and qualitative characterization of GBM topography. Invasiveness, tumor burden, and EOR were key predictors of survival, while MGMT methylation had limited spatial prognostic value. Incorporating voxel count into preoperative evaluation may enhance prognostic stratification and surgical planning in GBM.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148850836","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":"Safety and postoperative outcomes following nerve root ligation and transection for patients with CSF-venous fistulas: a cohort study.","authors":"Ahmed Helal, Ross Moseley, Mohamed M Salem, Andrew L Callen, Peter Lennarson","doi":"10.3171/2026.3.JNS252704","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252704","url":null,"abstract":"<p><strong>Objective: </strong>Spontaneous intracranial hypotension (SIH) is an increasingly recognized disease entity presenting with a range of symptoms, the most common of which is orthostatic headaches. Bern scores have been validated to determine the probability of SIH on brain MRI. Spinal CSF leaks represent an important underlying etiology, with approximately 20% caused by CSF-venous fistulas (CVFs), or type III CSF leaks. Surgical ligation of CVFs is a reliable treatment option. The purpose of this study was to evaluate the outcomes of surgical ligation of CVFs and determine predictors of good outcomes.</p><p><strong>Methods: </strong>This study was a retrospective review of prospectively collected data for all consecutive patients treated with nerve root ligation at the authors' institution between October 2021 and January 2025. Patient data were analyzed regarding improvement in preoperative symptoms, postoperative outcomes, quality of life, and any complications.</p><p><strong>Results: </strong>Twenty-six patients underwent surgery for CVFs with a median follow-up of 12 (IQR 5.5-18.5) months. Twenty-two (84.6%) of 26 patients showed improvement in preoperative symptoms, with 94% showing an improvement in the Bern score at the last follow-up evaluation. Only 1 patient developed radicular pain severe enough to require further intervention, and there were no other complications reported. At last follow-up, 83.3% of patients were able to return to work. The overall preoperative Bern score was significantly correlated with postoperative outcomes. Last, self-evaluated quality of life outcomes were significantly correlated with preoperative Bern scores.</p><p><strong>Conclusions: </strong>Nerve root ligation is a safe and effective treatment option, and overall Bern score and venous congestion were predictive of postoperative outcomes and quality of life.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794204","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":"Editorial. Improving the management of polytrauma patients admitted with mild traumatic brain injury.","authors":"Mario Ganau","doi":"10.3171/2026.2.JNS26175","DOIUrl":"https://doi.org/10.3171/2026.2.JNS26175","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":3.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794172","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}