Journal of neurosurgery最新文献

{"title":"Surgery of peritorcular meningiomas: the structural basis for preservation of torcular venous flow.","authors":"Anil Can, Alice Giotta Lucifero, Anna Brettler, Kaith Almefty, Emad Aboud, Andres Santos, Murat Gokden, Ian F Dunn, Ossama Al-Mefty","doi":"10.3171/2025.4.JNS25359","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25359","url":null,"abstract":"<p><strong>Objective: </strong>Surgical removal of torcular meningiomas is a considerable challenge. The authors studied the anatomical structure of the torcula to identify a dissecting plane that allows for the removal of the tumor while maintaining the integrity and patency of the venous component. Here, they describe the anatomy and surgical technique applied in a cohort of patients with torcular meningiomas.</p><p><strong>Methods: </strong>In four formalin-fixed cadavers, the architecture of the torcula and connecting sinuses was studied using various stains. Accordingly, the authors categorized meningioma invasion of the torcula into different types based on the integrity of the venous component. They described the corresponding surgical techniques and retrospectively analyzed the medical records of a series of 14 patients with torcular meningiomas operated on between 1997 and 2018.</p><p><strong>Results: </strong>The histological preparation revealed that the torcular wall consists of two distinct compartments, an inner venous structure with a layer of endothelium surrounding the lumen, supported by an extra-endothelial layer composed of elastic fibers associated with multiple layers of thin smooth muscle fibers. Surrounding this inner venous structure is the dural fibrous structure. Between the dural fibrous component and the venous component, there is a collagenous layer that forms a cleavage plane, facilitating delamination. This cleavage made it possible to resect the tumor and maintain the integrity of the venous wall and venous flow. Based on the anatomical involvement of the torcular wall, the authors categorized torcular meningiomas into four types. Fourteen patients were managed based on this classification. In types I and II, the venous compartment is intact, flow is maintained, and the surgical technique for removing the tumor is described. In types III and IV, the tumor has disrupted the venous compartment and flow, and these tumors were removed with utmost care for preservation of collateral venous channels.</p><p><strong>Conclusions: </strong>The anatomical composition of the torcular wall provides a plane of dissection to remove torcular meningiomas with preservation of venous channels and flow in cases in which the inner venous wall is not disrupted (types I and II). Tumors with occlusion of the torcula (types III and IV) mandate preservation of venous collaterals.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859285","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 preoperative sinusitis on surgical outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery: a real-world population-based cohort study.","authors":"Chia-En Wong, Yu Chang, Yen-Ta Huang, Heng-Jui Hsu, Da-Wei Huang, Heng-Juei Hsu, Jung-Shun Lee","doi":"10.3171/2025.4.JNS243094","DOIUrl":"https://doi.org/10.3171/2025.4.JNS243094","url":null,"abstract":"<p><strong>Objective: </strong>The endonasal endoscopic transsphenoidal approach (ETA) is the standard approach for pituitary adenomas (PAs). Chronic sinusitis is a prevalent condition affecting 2%-15% of the general population. However, the impact of preoperative sinusitis on the outcomes of ETA for PA remains unknown. This study investigated the impact of preoperative sinusitis on the outcomes of ETA for PA.</p><p><strong>Methods: </strong>A retrospective cohort analysis was conducted using the TriNetX database. Propensity score matching (PSM) was performed to form two balanced groups to compare patients with and without preoperative chronic sinusitis who underwent subsequent ETA for PAs. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the TriNetX platform to compare the perioperative and neuroendocrine outcomes.</p><p><strong>Results: </strong>The crude cohort included a total of 10,675 patients. After PSM, 842 patients were included in both the sinusitis and nonsinusitis groups. The mean age at ETA was 54.3 and 55.0 years in the sinusitis and nonsinusitis groups, respectively. Compared to the nonsinusitis group, patients in the sinusitis group had a higher incidence of postoperative CSF leakage (OR 1.47, 95% CI 1.06-2.03; p = 0.021), meningitis (OR 2.47, 95% CI 1.25-4.87; p = 0.007), postoperative diabetes insipidus (DI) (OR 1.47, 95% CI 1.17-1.83; p = 0.001), desmopressin use (OR 1.77, 95% CI 1.34-2.33; p = 0.001), and steroid use (OR 1.46, 95% CI 1.15-1.85; p = 0.002). Sensitivity analysis demonstrated consistent results across the different matching models.</p><p><strong>Conclusions: </strong>In patients who underwent ETA for PAs, preoperative sinusitis was associated with an increased risk of postoperative CSF leakage, meningitis, DI, desmopressin use, and steroid use.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804296","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":"Posttreatment toxicity following single-fraction versus multifraction hypofractionated stereotactic radiosurgery for larger meningiomas.","authors":"Eleanor C Smith, Rebecca L Calafiore, Reid R Christensen, Carol Kittel, Michael T Munley, Christina K Cramer, Stephen B Tatter, Jaclyn J White, Michael D Chan, Adrian W Laxton","doi":"10.3171/2025.4.JNS242824","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242824","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic radiosurgery (SRS) has been used to manage patients with intracranial meningioma with contraindications to resection. Limitations to SRS traditionally include tumors > 3 cm due to the risk of posttreatment toxicity. Hypofractionated SRS (hSRS) has been proposed as an alternative for tumors exceeding volume constraints for single-fraction SRS, although how hypofractionation affects the volume versus toxicity relationship has not been reported. Thus, the authors conducted a single-institution retrospective analysis of the medical records of patients receiving single-fraction SRS or multifraction hSRS for large (> 2 cm) meningiomas to assess the effect of hypofractionation on the likelihood of posttreatment toxicity.</p><p><strong>Methods: </strong>Patients were identified using the Wake Forest University Department of Radiation Oncology prospectively administered Gamma Knife database. Patients were included if they had single-fraction SRS or multifraction hSRS for a diagnosis of meningioma that was > 2 cm. Analysis was limited to tumor volumes between 2.7 and 49.3 cm3, the overlapping range shared by those undergoing hSRS or SRS. Electronic medical records were used to determine patient and tumor characteristics and clinical outcomes.</p><p><strong>Results: </strong>A total of 121 SRS cases with a median dose of 12 Gy and 51 hSRS cases with a median dose of 20 Gy with tumor volumes between 2.7 and 49.3 cm3 were identified and included in the analysis. The probabilities of freedom from local failure at 1, 3, and 5 years were 87.0%, 79.0%, and 63.6%, respectively, for patients receiving single-fraction SRS and 96.0%, 91.0%, and 91.0%, respectively, for patients receiving multifraction hSRS. The probabilities of overall survival at 1, 3, and 5 years were 97.5%, 79.7%, and 72.6%, respectively, for patients receiving single-fraction SRS and 85.5%, 80.9%, and 76.4%, respectively, for patients receiving multifraction hSRS. Eighteen (14.9%) of 121 patients receiving single-fraction SRS experienced Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 2 toxicity, and 12 (23.5%) of 51 patients receiving multifraction hSRS experienced CTCAE grade ≥ 2 toxicity.</p><p><strong>Conclusions: </strong>When controlling for tumor volume, despite higher treatment doses in the hSRS group relative to the SRS group, posttreatment toxicity was not significantly different between the groups, and freedom from local failure was improved in the hSRS group. For patients with larger meningiomas, multifraction hSRS may help to limit the risk of posttreatment edema and toxicity, while maintaining acceptable freedom from local failure.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144804297","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 adjuvant radiation therapy on outcomes in grade 2 conventional chondrosarcoma.","authors":"Franco Rubino, Georgios A Zenonos, Hanna Algattas, Paul A Gardner, Juan C Fernandez-Miranda, Vera Vigo, Franco DeMonte, Shaan M Raza","doi":"10.3171/2025.3.JNS242797","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242797","url":null,"abstract":"<p><strong>Objective: </strong>While histological subtype and grade are important for guiding treatment of skull base chondrosarcomas, the role of adjuvant radiation therapy (RT) and the optimal radiation modality for grade 2 conventional chondrosarcoma (cCS) are not well defined. The aim of this study was to further elucidate optimal treatment strategies for grade 2 cCS.</p><p><strong>Methods: </strong>Multi-institutional data from the Skull Base Chondrosarcoma Consortium, including patient demographics, radiological features, and outcomes, were analyzed retrospectively. Clinical and radiological follow-up data were used to assess disease stability or progression after different treatments. The impact of RT on progression-free survival (PFS) was evaluated with an interaction model and a pairwise comparison.</p><p><strong>Results: </strong>A total of 79 patients (44 female, mean age 47 years) with grade 2 cCS were identified, with a mean follow-up duration of 74.6 ± 67 months. The 10-year overall survival rate was 68%. Forty-four patients (56%) were treated with surgery followed by postoperative surveillance and 35 patients (44%) were treated with surgery and adjuvant RT. Gross-total resection (GTR) was achieved in 29 patients (36.7%), and adjuvant RT was most frequently used after subtotal resection (STR) (61%, 28/46). The prevailing RT technique used was proton beam RT (PBRT) (71%, n = 25). In terms of PFS, adjuvant RT significantly decreased the likelihood of disease progression (HR 0.26, 95% CI 0.10-0.65; p = 0.004). Adjuvant RT had significantly greater benefit after incomplete resection, with significant PFS improvement after incomplete resection (HR 3.73, 95% CI 1.24-11.1; p = 0.02) but only a nonsignificant positive trend toward benefit after GTR (HR 0.15, 95% CI 0.001-1.36; p = 0.105). While the interaction term (HR 1.36, 95% CI 0.12-191.05; p = 0.838) was not significant, the pairwise comparison between STR alone and STR+RT was significant (p = 0.008), demonstrating a clear impact of adjuvant RT in this subgroup.</p><p><strong>Conclusions: </strong>These findings suggest that in the setting of an incomplete resection, adjuvant RT is indicated to achieve optimal long-term tumor control rates. Surgery with subsequent close follow-up after complete resection in grade 2 cCS appears to be an acceptable decision, but more evidence is needed. The capacity of PBRT to concentrate higher radiation doses at the tumor site appears to be an important factor in local control.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764988","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 integrated spatial transcriptomics and histopathological analysis in adamantinomatous craniopharyngiomas to identify stromal cells as a new cellular source of leukemia inhibitory factor.","authors":"Wenxin Hu, Chuan Zhao, Wenrong Zheng, Yi Lin, Ning Luo, Hongxing Liu, Xingfu Wang, Xueling Qi, Xianlong Wang, Xiao-Nan Li, Zhixiong Lin","doi":"10.3171/2025.4.JNS243146","DOIUrl":"https://doi.org/10.3171/2025.4.JNS243146","url":null,"abstract":"<p><strong>Objective: </strong>Adamantinomatous craniopharyngioma (ACP) is an epithelial tumor that occurs in the sellar region of the human brain. Despite resection, relapse is frequent with poor prognosis. To facilitate the development of new therapy for ACP, the authors examined the spatial distribution, cell of origin, and potential biological functions of leukemia inhibitory factor (LIF), an important stem cell self-renewal regulator, in a series of ACP tumors.</p><p><strong>Methods: </strong>The transcriptional sites of LIF and LIF receptor (LIFR) were determined by single-cell sequencing and space transcriptome analysis. LIF and LIFR distribution characteristics in different histopathological regions were detected with immunohistochemistry and immunofluorescence analysis. The relationships between the regional distributions of different tissues and tumor imaging characteristics, tumor cell stemness, cell proliferation, LIF expression, and patient prognosis were analyzed.</p><p><strong>Results: </strong>The authors' analysis of 39 ACPs detected LIF overexpression that was selectively enriched in cell clusters. In addition to the discovery of the stromal cells in the interstitial region, palisade epithelium, and stellate reticulum as the source cells of LIF production, the authors also revealed that LIFR was primarily generated by the cell clusters. Examination of differentially expressed genes between LIF-high and LIF-low ACP tumors indicated that the binding of LIF to LIFR may lead to the activation of the PI3K-AKT signaling pathway. Further analysis showed enrichment of LIF expression in β-catenin-positive cell clusters expressing stem cell markers of CD44, supporting its role in stem cell self-renewal. Integrated analysis with diagnostic imaging found higher level expression of LIF in cystic tumors than in solid tumors, displaying a trend toward poorer prognosis.</p><p><strong>Conclusions: </strong>This study confirmed for the first time that LIF in ACP mainly originates from tumor microenvironment stroma. The authors' data suggest that future efforts should also include tumor stromal cells as a novel cellular and/or molecular target when developing new anticancer therapies against ACP.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764991","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":"Longitudinal neurocognitive outcomes and predictors after unilateral combined cerebral revascularization in adult moyamoya vasculopathy.","authors":"Ruiyuan Weng, Jiabin Su, Hanqiang Jiang, Heng Yang, Xinjie Gao, Yanjiang Li, Zhiwen Jiang, Yuchao Fei, Zeran Yu, Chao Gao, Wei Ni, Yuxiang Gu","doi":"10.3171/2025.4.JNS243119","DOIUrl":"https://doi.org/10.3171/2025.4.JNS243119","url":null,"abstract":"<p><strong>Objective: </strong>While most studies on adult moyamoya vasculopathy (MMV) have focused on the stroke incidence after bypass surgery, neurocognitive outcomes and predictors have rarely been investigated. The aim of this study was to evaluate the neurocognitive outcomes of adult patients with MMV after combined revascularization surgery and identify factors contributing to unfavorable outcomes.</p><p><strong>Methods: </strong>Adult patients with MMV who underwent combined revascularization surgery from March 2019 to July 2024 at a single center were prospectively observed. Neuropsychological assessments and DSA were performed approximately 6 months after surgery. Neurocognitive changes were assessed using a distribution-based approach to calculate the minimal clinically important difference.</p><p><strong>Results: </strong>A total of 204 patients (mean age 43.8 years) were included in the analysis, with a mean ± SD follow-up duration of 183.0 ± 18.2 days. Postoperatively, 166 patients (81.4%) demonstrated favorable neurocognitive outcomes, with 94 patients (46.1%) showing significant improvement and 72 patients (35.3%) remaining stable. Conversely, 38 patients (18.6%) experienced significant neurocognitive deterioration. The prevalence of vascular cognitive impairment (VCI) (p < 0.001) and the modified Rankin Scale scores (p = 0.002) significantly decreased following bypass. Multivariate analysis identified postoperative stroke complications (OR 3.57 [95% CI 1.47-8.68], p = 0.005) and posterior cerebral artery involvement (OR 2.23 [95% CI 1.01-4.93], p = 0.047) as independent risk factors for neurocognitive deterioration. Diabetes mellitus (OR 3.86 [95% CI 1.62-9.19], p = 0.002) and left-sided surgery (OR 2.01 [95% CI 1.09-3.70], p = 0.025) were independent risk factors against neurocognitive improvement, while the hemorrhagic type of MMV (OR 0.36 [95% CI 0.17-0.72], p = 0.004) was an independent protective factor.</p><p><strong>Conclusions: </strong>Combined revascularization surgery appears to be an effective treatment for improving neurocognition in patients with MMV and VCI. Insufficient preexisting collateral reserve and postoperative stroke complications might contribute to neurocognitive deterioration, while diabetes mellitus and left-sided surgery hindered neurocognitive improvement.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764989","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":"Optimal imaging follow-up strategies for conservatively managed cerebral cavernous malformations: a cost-effectiveness analysis.","authors":"Aryan Wadhwa, Mira Salih, Felipe Ramirez-Velandia, Samuel D Pettersson, Sandeep Muram, Michael Young, Philipp Taussky, Christopher S Ogilvy","doi":"10.3171/2025.4.JNS243100","DOIUrl":"https://doi.org/10.3171/2025.4.JNS243100","url":null,"abstract":"<p><strong>Objective: </strong>Cavernous malformations are low-flow vascular anomalies within the central nervous system, notable for their potential to cause seizures or intraparenchymal hemorrhage. Currently, no consensus exists to recommend a specific interval for following radiographic imaging of cerebral cavernous malformations (CCMs) that are not treated with either resection or radiation. Herein, the authors aimed to determine the most cost-effective strategy for MRI follow-up of CCM in both brainstem and nonbrainstem locations in order to enable earlier diagnosis and potentially circumvent fatal events due to CCM-related hemorrhages.</p><p><strong>Methods: </strong>A decision analysis was performed using a Markov model with Monte Carlo simulations for patients with CCMs undergoing MRI follow-up at different time intervals (0.5-, 1-, 2-, and 3-year intervals). Input data for the model were extracted from the current literature, primarily meta-analyses, and the willingness-to-pay threshold was defined as $50,000 per quality-adjusted life year (QALY), as standard in the United States. Probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of the model.</p><p><strong>Results: </strong>Given the current literature and the authors' model, MRI follow-up every 1 year for brainstem CCM is the most cost-effective strategy (cost $395,580, effectiveness 20.42 QALYs), showing the highest net monetary benefit. For nonbrainstem CCM, follow-up every 3 years with MRI was the most cost-effective strategy (cost $125,438, effectiveness 23.23 QALYs). This conclusion remains robust in probabilistic and deterministic sensitivity analyses.</p><p><strong>Conclusions: </strong>For patients followed conservatively, the most cost-effective follow-up strategy for brainstem CCM using MRI is every 1 year, while for nonbrainstem CCM, follow-up every 3 years tends to be the most cost-effective. More frequent follow-up strategies for nonbrainstem CCM or prompt preventive treatment would be more appropriate in symptomatic patients or patients with higher risk factors for hemorrhagic events.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764990","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 pain control and reduced opioid use through novel selection criteria for peripheral nerve and motor cortex stimulation.","authors":"Kelsey DeLisio, Jonathan Miller, Jennifer Sweet","doi":"10.3171/2025.2.JNS232686","DOIUrl":"https://doi.org/10.3171/2025.2.JNS232686","url":null,"abstract":"<p><strong>Objective: </strong>Peripheral nerve stimulation (PNS) and motor cortex stimulation (MCS) for medically refractory neuropathic facial pain offer an alternative to traditional surgical approaches and therapeutic techniques. Many existing studies lack large sample sizes, long-term follow-up, or clear patient selection guidelines, making well-defined outcomes variable. The objective of this cohort study was to present a large series of patients with PNS or MCS and long-term outcomes and propose an algorithm for determining which surgical technique to use according to patient histories and physical examinations.</p><p><strong>Methods: </strong>Thirty-three consecutive cases of trial and permanent placement of PNS and MCS electrodes by two surgeons at a single site from January 2013 through March 2023 were retrospectively reviewed from a prospectively collected database to assess pain coverage and surgical outcomes. The average length of follow-up for this cohort was 30.12 (range 2-104) months.</p><p><strong>Results: </strong>Of those who reported at least good reduction of pain at trial (≥ 50% reduction), 80.0% of PNS and 72.7% of MCS patients experienced good (50%-74% pain relief) or excellent (75%-100% pain relief) coverage for 6 months or longer. Sixty-two percent of presurgical opioid users switched to nonopioid medications or no medication following surgery. Fifty-seven percent of patients proceeded with end-of-life implantable pulse generator revision given their continued pain relief.</p><p><strong>Conclusions: </strong>Careful consideration of patient eligibility for PNS and MCS based on pain distribution and quality results in better overall outcomes, decreased opioid use, and long-term device usage in patients with neuropathic head and facial pain seeking surgical intervention.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715118","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":"Ki-67 in meningioma: distribution and implications.","authors":"Xiaopeng Guo, Ruchit V Patel, James A Lederer, David M Meredith, Wenya Linda Bi","doi":"10.3171/2025.4.JNS25438","DOIUrl":"https://doi.org/10.3171/2025.4.JNS25438","url":null,"abstract":"<p><strong>Objective: </strong>Ki-67 is a widely used marker of proliferation in meningiomas, influencing prognostic assessment and treatment decisions, including adjuvant radiation therapy. However, it is increasingly appreciated that some meningiomas are enriched with immune infiltration, which may confound Ki-67 interpretation as both immune and tumor cells exhibit proliferative potential. The authors aimed to dissect the cellular source and distribution of Ki-67 within the meningioma microenvironment and explore their clinical, genomic, and biological associations.</p><p><strong>Methods: </strong>The cellular composition of 32 resected meningiomas, including tumor and immune lineages, was profiled with single-cell mass cytometry (cytometry by time of flight [CyTOF]) and single-cell RNA sequencing (scRNAseq). The Ki-67 index and mitotic count were assessed by immunohistochemistry. CDKN2A/B deletion and high-risk chromosome alterations were evaluated to establish a molecular Integrated Grade. An extrapolation cohort of 448 newly diagnosed meningiomas with gross-total resection was used for validation.</p><p><strong>Results: </strong>Ki-67 is expressed by multiple cell lineages, both tumor and immune, as inferred by CyTOF on 77,498 cells and scRNAseq on 45,460 cells. The composition of cells contributing to Ki-67 expression changes from WHO grade 1 to grades 2 and 3, with Ki-67+ cells in WHO grade 1 tumors composed of mostly myeloid-lineage cells, while nonimmune tumor cells dominated Ki-67+ cells in grade 2 and 3 meningiomas. Ki-67 indices were markedly elevated in meningiomas from older patients (age > 70 years) and influenced by the timing of radiation exposure. The optimal Ki-67 threshold associated with future recurrence varied with time of follow-up. Furthermore, the authors highlight two scenarios of focally elevated Ki-67 expression, central infarction and extramedullary hematopoiesis, in which apparent proliferation does not correlate with tumor aggressiveness.</p><p><strong>Conclusions: </strong>These findings unveil the complexity of Ki-67 expression in meningiomas, emphasizing the need for a nuanced interpretation of proliferation indices. The Ki-67 index remains a reliable parameter for assessing the clinical, molecular, and prognostic characteristics of meningiomas on careful evaluation and consideration of potential confounding factors.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715117","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":"Identification and relevance of ultra-early progression after resection of glioblastoma.","authors":"Levin Häni, Arsany Hakim, Lorenz Gehrig, Michal Staruch, Johannes Goldberg, Severin Rüssli, Nicole Söll, Andreas Raabe, Ekin Ermiş, Philippe Schucht","doi":"10.3171/2025.3.JNS242212","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242212","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to analyze the relevance of tumor progression in the interval between surgery and radiation therapy (RT) in patients with glioblastoma and its interaction with the extent of resection.</p><p><strong>Methods: </strong>In a retrospective cohort study, all patients who underwent resection for glioblastoma, IDH wildtype, at a single institution from January 2011 to February 2023 with early postoperative and additional pre-RT MRI available for analysis were included. Early postoperative MR images were graded according to whether they showed no enhancing or nonenhancing residual tumor (group 1a), no contrast-enhancing but residual nonenhancing tumor (group 1b), or residual contrast-enhancing tumor (group 2). The primary outcome was overall survival. Risk factors for ultra-early progression were assessed using a binary logistic regression analysis.</p><p><strong>Results: </strong>A total of 133 patients (median age 66.0 years) were included, and 64 patients (48.1%) had ultra-early progression. Overall survival was significantly worse among patients with ultra-early progression (p < 0.001). The only risk factor identified for ultra-early progression was the resection category (p < 0.001). While ultra-early progression was seen in 10.3% of patients in group 1a, it occurred in 43.8% and 85.2% of patients in groups 1b and 2, respectively (p < 0.001). Patients with ultra-early progression showed no difference in survival whether or not they had undergone complete resection of enhancing tumor (p = 0.850).</p><p><strong>Conclusions: </strong>Ultra-early progression after resection of a glioblastoma is a frequent finding with a profound prognostic impact. Complete resection of enhancing and nonenhancing tumors reduced the frequency of ultra-early progression. Nevertheless, new strategies for management of ultra-early progression are urgently needed to improve prognosis.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715116","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}