Journal of neurosurgery最新文献

{"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}

{"title":"Clinical course of mild traumatic brain injury in polytrauma patients admitted to intensive care.","authors":"Yehia El Bendary, Cornelia Hounkonnou, Caroline Jeantrelle, Jean-Denis Moyer, Gueorgui Iakovlev, Philippe Decq, Matthieu Faillot","doi":"10.3171/2026.1.JNS251936","DOIUrl":"https://doi.org/10.3171/2026.1.JNS251936","url":null,"abstract":"<p><strong>Objective: </strong>Mild traumatic brain injury (mTBI) accounts for the majority of TBI cases. In polytrauma patients admitted to intensive care units (ICUs), mTBI may be associated with more severe clinical profiles and a higher risk of intervention. However, the outcomes and characteristics of this population remain underdescribed.</p><p><strong>Methods: </strong>The authors conducted a retrospective study of adult patients with mTBI (Glasgow Coma Scale [GCS] score ≥ 13) admitted to the ICU of a level I trauma center from 2011 to 2017. Patients with secondary neurological deterioration prior to ICU admission were excluded. The authors specifically assessed the presence of intracranial lesions, need for neurosurgical interventions, and clinical outcomes including in-hospital mortality. Statistical analyses included descriptive statistics, univariate comparisons, and multivariate logistic regression models to identify factors independently associated with neurosurgical intervention and mortality.</p><p><strong>Results: </strong>Among 244 patients (82% male, mean age 41.3 years), 82.8% had traumatic intracranial lesions. Neurosurgical intervention was required in 22.1% of cases, and the mortality rate was 3.3%. Subarachnoid hemorrhage, subdural hematoma, and epidural hematoma were the most common imaging findings. Independent predictors of neurosurgical intervention included epidural hematoma, midline shift > 5 mm, and assault-related trauma. Mortality was associated with age and hemorrhagic shock. Functional outcomes were favorable in most patients, but 24% had disability at discharge.</p><p><strong>Conclusions: </strong>In polytrauma patients admitted to the ICU, mTBI is often accompanied by intracranial injuries and a substantial need for surgical intervention, even when the GCS score is high.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794198","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 myth of the supplementary motor area syndrome: the etiology of motor deficits after dorsomedial frontal resections.","authors":"Antonio Dono, Shalin Shah, Maria Morkas, Kathryn Snyder, Ellery Wheeler, Yoshua Esquenazi, Nitin Tandon","doi":"10.3171/2026.3.JNS252548","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252548","url":null,"abstract":"<p><strong>Objective: </strong>Resections of the supplementary motor area (SMA) in the dorsomedial frontal cortex (DMFC) have traditionally been thought to result in predictable postoperative motor deficits termed the \"SMA syndrome.\" However, the true incidence, etiology, and duration of these deficits seem overstated in the modern era. Herein, the authors aimed to critically evaluate and reassess the SMA syndrome in the context of surgical navigation, retractorless surgery, and contemporary motor mapping and monitoring techniques.</p><p><strong>Methods: </strong>The authors retrospectively reviewed the electronic medical records of all patients who underwent DMFC resections for tumors or epilepsy between 2004 and 2025 at a single institution. Patients with insufficient data were excluded from the study. Compiled data included demographics, presenting symptoms, surgical characteristics, intraoperative mapping, postoperative motor function, postoperative complications, and follow-up visits up to 12 weeks.</p><p><strong>Results: </strong>Eighty patients were eligible for study inclusion. New postoperative motor deficits occurred in 33.8% of patients (27/80); however, when cases with concomitant involvement of the primary motor cortex or cingulate gyrus were excluded, the incidence of SMA-specific deficits was only 10.0% (8/80). Moreover, 81.5% of new deficits (22/27) resolved by a median of 13 days, and 51.9% (14/27) recovered very rapidly. Patients with new deficits were more likely to have right hemisphere resections (p = 0.033). Motor strip involvement (p = 0.019) and postoperative complications (p = 0.042) were also associated with new deficits. No association was found with the use of intraoperative mapping, percentage of resected SMA, or other clinical characteristics. As expected, patients with new deficits experienced a longer postoperative hospital course (p = 0.023) and were more often discharged to inpatient rehabilitation (p = 0.012). Permanent deficits occurred in 6.3% of patients (5/80) and were more often associated with preoperative weakness (p = 0.047) and a major postoperative complication (p = 0.013).</p><p><strong>Conclusions: </strong>These findings challenge the classic perspectives on SMA syndrome. When resections are confined to the SMA, postoperative deficits are uncommon, mild, and resolved rapidly. Persistent deficits reflect injury to adjacent eloquent regions rather than injury from the SMA resection itself. With gravity-based retraction, modern navigation, and functional mapping, DMFC lesions can be resected more safely than in the past. Study findings support redefining SMA syndrome and expanding the role of mapping-guided resections in this region.</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":"148794200","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":"Multidisciplinary practice in vestibular schwannoma surgery over a decade: optimizing facial nerve and hearing outcomes and analyzing the predictive role of tumor-related radiological features.","authors":"Mehdi Khaleghi, Je Beom Hong, Mohammad Bilal Alsavaf, Kyle C Wu, Vivian Kaul, Robert J Macielak, Douglas A Hardesty, Luciano Prevedello, Edward E Dodson, Oliver F Adunka, Daniel M Prevedello","doi":"10.3171/2026.2.JNS251713","DOIUrl":"https://doi.org/10.3171/2026.2.JNS251713","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Satisfactory facial nerve (FN) and hearing preservation rates associated with modern vestibular schwannoma (VS) surgery potentially reflect the surgeon's expertise established over years. While advanced MRI can estimate cranial nerve topography and tumor traits, radiological predictors of postoperative functional outcomes across three standard surgical approaches remain unclear. The aim of this study was to address this gap by determining independent radiological predictors of FN and hearing outcomes, stratified by surgical approach, while considering the influence of the surgeon learning curve stage.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors retrospectively reviewed patients with VS who underwent resection between July 2012 and July 2023 at their institution. Potential radiological predictors of postoperative hearing and FN results were examined using multivariate regression analysis. To examine the learning curve impact on FN and hearing outcomes, the first 100 and first 24 operated cases, respectively, were compared with the most recent cases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 187 patients (103 female, median age 52 years) included in this analysis. The median tumor size and fundal CSF space (FCS) horizontal diameter were 17.7 mm and 3.2 mm, respectively. MRI revealed FCS presence in 67.9%, T2-weighted hyperintensity in 44.9%, and heterogeneous contrast enhancement in 28.8% of patients. Intraoperative FN monitoring (IOFM) showed favorable responses in 77.1% of patients, and V-wave preservation was confirmed by auditory evoked potential monitoring in 33.9%. The gross-total resection (GTR) rate was 66.3%. Favorable FN functional outcomes were observed in 73.3%, 83.3%, and 86.8% of patients at early, short-term, and long-term postoperative evaluations, respectively, with favorable IOFM being a consistent predictor. FCS presence (OR 2.94, 95% CI 1.06-8.14; p = 0.038) and GTR (92.1% vs 77.3%, p = 0.016) were independently correlated with superior early and long-term FN results, respectively. Subgroup analysis revealed that FCS presence predicted better short- and long-term FN outcomes only in retrosigmoid cases, whereas heterogeneous enhancement was correlated with worse results in translabyrinthine cases. Serviceable hearing was preserved, when attempted, in 41.7% of patients; higher trends were seen with FCS size ≥ 3 mm, nonheterogeneous tumors, retrosigmoid cases, and earlier surgeon experience. The learning curve stage was not correlated with overall FN outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A multidisciplinary surgical team can achieve favorable FN and hearing results in neuromonitoring-guided VS surgery, regardless of the surgeon's learning curve stage. FCS presence was a positive prognosticator of FN outcomes in retrosigmoid cases, while the translabyrinthine approach offered inferior results in cystic tumors. Larger case-volume studies are warranted to reliably evaluate middle cranial fossa c","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.8,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148794214","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":"Conditioning electrical stimulation after nerve injury: a clinically feasible strategy to enhance peripheral nerve regeneration.","authors":"Christine A Webber, Karyne N Rabey, K Ming Chan, Jenna-Lynn Senger","doi":"10.3171/2026.3.JNS252571","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252571","url":null,"abstract":"<p><strong>Objective: </strong>Early repair of transected peripheral nerves is advocated to maximize recovery; however, clinical delays are common. Conditioning, a well-known method accelerating nerve regeneration, has never been used in a postinjury setting. The authors tested whether postinjury, prerepair conditioning electrical stimulation (CES) can biologically bridge the interval to surgery so that a delayed repair (DR) yields outcomes comparable to, or greater than, an immediate repair (IR).</p><p><strong>Methods: </strong>Adult male Sprague Dawley rats were randomized to 4 cohorts: 1) CES-cut-IR (CES 1 week before nerve cut + IR), 2) cut-IR (cut and IR, no CES), 3) cut-DR (cut, DR 10 days later, no CES), and 4) cut-CES-DR (nerve cut, CES on postinjury day 3, DR 7 days later). Outcomes evaluated included axon extension 14 days postrepair, sensory recovery (von Frey thresholds, intraepidermal nerve fiber density), and motor recovery (toe-spread and ladder-rung performance, compound muscle action potential [CMAP] amplitudes, gastrocnemius mass, and innervated neuromuscular junctions [NMJs]).</p><p><strong>Results: </strong>For all outcomes evaluated, postinjury CES significantly improved regeneration and reinnervation when compared with no-CES controls. Furthermore, this cohort also had outcomes comparable to the IR cohort that had been treated with CES. Axon extension was comparable between the cut-CES-DR (12.5 ± 0.9 mm) and the CES-cut-IR positive-control cohort (12.1 ± 0.7 mm), and significantly longer than cut-IR (6.9 ± 0.6 mm, p < 0.001) and cut-DR (7.2 ± 0.5 mm, p < 0.001) controls. Between 7 and 8 weeks postrepair, sensory recovery assessed with von Frey filaments identified sensory recovery in the cut-CES-DR cohort comparable to the CES-cut-IR positive control, and significantly greater than the cut-IR and cut-DR controls (both p < 0.001); these results were confirmed on intraepidermal nerve fiber density counts. At 8 weeks, motor function was improved in the cut-CES-DR cohort (toe spread 73.2% contralateral; ladder score 5.0 ± 0.1) versus cut-IR and cut-DR cohorts (approximately 43%; scores 3.6 and 3.3, respectively; p < 0.001), approximating CES-cut-IR cohort. This was confirmed by CMAP amplitudes, gastrocnemius muscle mass, and quantification of innervation NMJs, which demonstrated similar trends.</p><p><strong>Conclusions: </strong>A single, brief CES session delivered after injury and before repair enables delayed neurorrhaphy to recapitulate IR biology, significantly improving regeneration and reinnervation over delayed or IR without CES. This is the first demonstration of a conditioning-like effect in the clinically relevant situation of an already transected nerve. These results position postinjury CES as a practical bridge to surgery for timing-constrained nerve repairs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765127","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}