Journal of neurosurgery最新文献

{"title":"Early experience using optical coherence tomography for intraluminal evaluation of vascular healing associated with endovascular treatment of intracranial aneurysms.","authors":"José de Jesús Gutiérrez-Baños, Carlos Castillo-Rangel, Mauricio Ivan Rodriguez-Pereira, Jorge Octavio Lopez Esparza, Daniel Oswaldo Dávila-Rodríguez, Jecsán Tovar-Fuentes, Alondra Sarai Tovar-Jiménez, Boris Leonardo Pabon Guerrero, Juan Alberto Hernández-López","doi":"10.3171/2025.1.JNS242458","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242458","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to observe the intraluminal characteristics of flow diverter devices and neurovascular stents immediately after placement using optical coherence tomography (OCT), with a focus on the presence of intrastent thrombosis and device apposition to the vascular wall. Additionally, the authors describe the postimplantation evolution, particularly vascular remodeling (neoendothelialization), aneurysm closure, and patency of the side branches.</p><p><strong>Methods: </strong>Intravascular OCT evaluations were performed 9 different times in 5 aneurysms treated via endovascular techniques in 5 female patients (median age 32.8 years). All patients were randomly selected and were on a daily regimen of dual antiplatelet therapy (acetylsalicylic acid at 100 mg and clopidogrel at 75 mg). Key findings included apposition, intrastent thrombus, neointima formation (neoendothelialization), aneurysm neck closure, and patency of the side branches.</p><p><strong>Results: </strong>OCT assessments were successfully completed in all cases. The cohort included 1 patient with a posterior circulation aneurysm treated with a stent and coils and 4 patients with anterior circulation aneurysms treated with flow diverters. No procedure-related complications were observed, and all cases showed proper device apposition without evidence of intrastent thrombosis. However, intrasaccular thrombosis occurred in 3 patients, with fibrin mesh and thrombus formation identified on the surface of the stent or flow diverter. Successful closure was achieved for all aneurysms, with satisfactory neointima formation and preserved patency of the side branches.</p><p><strong>Conclusions: </strong>Intravascular OCT was a feasible method to visualize the vascular remodeling process during treatment of intracranial aneurysms. It also provides a valuable decision-making tool by clearly highlighting potential complications, such as malapposition, intrastent thrombosis, or excessive endothelialization leading to stenosis. This study represents the second reported series using intravascular OCT in patients with intracranial aneurysms, and it includes the largest cohort to date. Further studies are needed to validate the utility of OCT in the neurovascular field, and development of dedicated OCT devices for intracranial navigation is essential.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015826","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 outcomes of peripheral nerve field stimulation in patients with refractory trigeminal neuralgia: a cohort study.","authors":"Johann Klein, Tareq A Juratli, Gabriele Schackert, Ilker Y Eyüpoglu, Majd A Alkhatib","doi":"10.3171/2025.1.JNS242951","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242951","url":null,"abstract":"<p><strong>Objective: </strong>Peripheral nerve field stimulation (PNFS) is a neuromodulatory surgical treatment used to treat severe refractory trigeminal neuralgia. However, most studies have had comparatively short follow-up periods. Thus, the authors performed a long-term analysis of patients who had received PNFS for trigeminal neuralgia.</p><p><strong>Methods: </strong>An institutional database was searched for patients who had received PNFS from 2012 to 2017. Only patients with trigeminal neuralgia who received a permanent implant were included. The electronic medical records were reviewed, and patients were contacted for outpatient appointments or telephone interviews. Perceived treatment effectiveness was the primary outcome parameter. Additionally, revision surgeries, other invasive treatments after PNFS implantation, system explants, and the painDETECT questionnaire (PD-Q) score at the latest follow-up were assessed.</p><p><strong>Results: </strong>Fifteen patients (6 male and 9 female; median age 70 years, range 45-87 years) were included in the analysis, 7 with classic trigeminal neuralgia and 8 with secondary trigeminal neuralgia (7 due to multiple sclerosis, 1 due to an inoperable meningioma). The median symptom duration was 11.5 years (range 2.5-17 years) and the median follow-up duration was 93 months (range 30-126, IQR 66.5-107 months). Half the male patients still perceived treatment effectiveness at the latest follow-up assessment, but none of the female patients did. Kaplan-Meier analysis with the log-rank test revealed a median time to failure of 2 years, with a median of 5.1 years in males and 1.5 years in females (p = 0.003). The median PD-Q score was 16 (range 0-27). There were 7 revision surgeries in 4 patients, and 4 patients underwent additional procedures after implantation.</p><p><strong>Conclusions: </strong>PNFS in trigeminal neuralgia is associated with a high rate of treatment failure in the long term, with females possibly experiencing worse results than males.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024561","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":"Accuracy and initial outcomes for stereotactic laser amygdalohippocampotomy using a fully MRI-compatible platform.","authors":"Yifei Sun, Faical Isbaine, J Nicole Bentley, Jennifer Cheng, Yarema B Bezchlibnyk, Robert E Gross, Jon T Willie","doi":"10.3171/2024.12.JNS241158","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241158","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive MRI-guided laser interstitial thermal therapy (MRgLITT) is an approach increasingly recognized as an effective tool for treating epileptic foci. Recent literature reports that stereotactic laser amygdalohippocampotomy (SLAH) for mesial temporal lobe epilepsy (MTLE) results in seizure-freedom rates comparable to those of analogous open selective amygdalohippocampectomy with a potentially more favorable neurocognitive adverse effect profile. However, many SLAH series show heterogenous results. The authors' objectives were to present the largest experience to date using a single MRI-compatible targeting platform (ClearPoint) for SLAH to treat MTLE and to report their analysis of accuracy and intraoperative factors correlated to complications and initial outcomes.</p><p><strong>Methods: </strong>The authors retrospectively collected data from all consecutive patients who underwent SLAH for MTLE using a single MRI-compatible targeting platform (ClearPoint) for SLAH at Emory University between June 2013 and October 2019. Univariable analysis, including the Student t-test, 1-way ANOVA, chi-square test, and Wilcoxon rank-sum test, was used to assess the relationship between surgical characteristics and outcomes.</p><p><strong>Results: </strong>The authors analyzed a total of 91 patients who underwent 97 procedures with 114 total trajectories between June 2013 and October 2019. All patients had a diagnosis of MTLE, as determined by scalp or intracranial EEG, with a mean ± SD age at surgery of 42.8 ± 12.9 years and a mean seizure onset age of 19.3 ± 14.7 years. The mean number of trajectories was 1.39 ± 0.6 (range 1-3), with an overall mean target error of 1.2 ± 1.0 mm (range 0.1-4.7 mm). Target errors improved significantly over time, demonstrating a learning effect. Entry-to-target distance was 106.5 ± 11.5 mm (range 62.6-127.3 mm) and did not correlate to error. At the 12-month follow-up, 46 (50.5%) had an Engel score I, 21 (23.1%) had an Engel score II, 16 (17.6%) had an Engel score III, 5 (5.5%) had an Engel score IV, and 3 were lost to follow-up. Of the 66 patients who had mesial temporal sclerosis (MTS), 38 (56%) had Engel score I, 15 (23%) had score II, 9 (14%) had score III, and 3 (4.5%) had score IV at 12 months, with 1 lost to follow-up. Of the 25 patients without MTS, 8 (32%) had Engel score I, 6 (24%) had score II, 7 (28%) had score III, and 2 (8.0%) had score IV at 12 months, with 2 lost to follow-up.</p><p><strong>Conclusions: </strong>The authors present the largest single-center experience using an MRI-compatible targeting platform for initial SLAH to treat MTLE. This technique results in safe laser ablation of epileptogenic tissue, with seizure outcomes comparable to those reported for open procedures. Further work is needed to validate its advantages over existing stereotactic approaches and the impact of multiple minimally invasive procedures.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143976225","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 propensity score-matched analysis of stereotactic radiotherapy for metastatic brain tumors using the Leksell Gamma Knife Icon Mask system: a single-center retrospective comparative study of cases meeting and not meeting the JLGK0901 Criteria.","authors":"Yuta Oi, Takuya Kawabe, Takahiro Ogawa, Ichita Taniyama, Takumi Yamanaka, Yoshinobu Takahashi, Manabu Sato, Naoya Hashimoto","doi":"10.3171/2025.1.JNS242424","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242424","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic radiosurgery (SRS) for metastatic brain tumors (METs) has previously been considered to be indicated only for cases with a few lesions with small sizes. Expansion of the indication of SRS for METs is mainly due to the JLGK0901 study. Furthermore, since introduction of Leksell Gamma Knife Icon system, both single-irradiation SRS and fractionated irradiation (stereotactic radiotherapy) have become possible using a mask fixation system. The purpose of this study was to evaluate the authors' own institutional experience in order to re-examine the limitations on the number and volume of lesions established in the JLGK0901 study.</p><p><strong>Methods: </strong>The study period was 6.5 years from the start of operations using the Leksell Gamma Knife Icon system at Rakusai Shimizu Hospital (September 2017 to February 2024). A retrospective study was conducted on 1043 patients who had undergone initial treatment with Gamma Knife Icon and had at least one posttreatment follow-up report. A comparison was made between cases that did (group A) and did not (group B, extended indication) meet the JLGK0901 criteria. Propensity score matching (PSM) was used to establish matched cases. Neurological death was the primary endpoint. Functional outcomes, imaging changes, and overall survival were secondary endpoints.</p><p><strong>Results: </strong>Of 1043 cases with newly diagnosed brain metastases treated with Gamma Knife Icon radiotherapy (GKRT) at Rakusai Shimizu Hospital, 673 (64.5%) were in group A and 370 (35.5%) in group B. PSM selected 321 cases in each group. The median survival time after GKRT was shorter in group B (19.7 vs 10.6 months, p < 0.01), but the incidence of neurological death did not differ significantly between the two groups (p = 0.635). There were also no significant differences in the rates of poor local control (p = 0.381), new distant intracranial lesions (imaging changes) (p = 0.925), neurological deterioration (p = 0.738), and severe radiation-induced adverse events (functional outcomes) (p = 0.994). Subgroup analysis of patients in group B with more than the allowed number of metastases or a greater tumor volume than that allowed in the JLGK0901 study showed no significant differences in neurological death and functional outcomes compared to group A for both subgroups.</p><p><strong>Conclusions: </strong>The results support expansion of the indication for Leksell Gamma Knife Icon for METs from that in JLGK0901 based on the absence of the influence of the number of metastases and tumor volume on outcomes.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of tumor, spine, and trauma neurosurgery in Ukraine: growth and resilience.","authors":"Oleksandr Strelko, Alex B Valadka, Luke Tomycz, Rocco A Armonda, Jonathan A Forbes, Gregory W J Hawryluk, James T Rutka, Andrii Sirko","doi":"10.3171/2025.3.JNS25684","DOIUrl":"https://doi.org/10.3171/2025.3.JNS25684","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012330","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":"Identifying proximity to white matter language tracts with gradient-based intraoperative electrical mapping.","authors":"Naomi Kahana, Akiva Korn, Naama Friedmann, Carla Richetta, Guy Gurevitch, Moran Artzi, Nimrod Keren, Zvi Ram, Tal Shahar, Rachel Grossman","doi":"10.3171/2025.1.JNS241036","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241036","url":null,"abstract":"<p><strong>Objective: </strong>Intraoperative identification of language white matter tracts (WMTs) is challenging, as these tracts are visually imperceptible. This study aimed to assess whether proximity to the language WMTs can be determined intraoperatively by correlating direct electrical stimulation (DES) intensity with the distance to language tracts as defined by preoperative diffusion tensor imaging (DTI)-based tractography.</p><p><strong>Methods: </strong>Twenty-eight patients undergoing awake craniotomy for diffuse glioma resection participated in the study. All patients received preoperative language assessments and DTI-based language tract reconstruction. Subcortical DES was applied along the tumor cavity border using bipolar or monopolar stimulation, with DES locations registered for offline analysis.</p><p><strong>Results: </strong>A positive linear correlation was found between the distance from the stimulated point to the closest language WMT and the subcortical DES electrical threshold (r = 0.57). Stimulation that evoked interference had a significantly lower intensity (mean 6.93, SD 3.82; n = 21) than noninterfering cases [mean 15.06, SD 7.4; n = 11; t(30) = 3.2, p < 0.001]. Tumor pathology, volume, and associated edema did not significantly affect the distance-intensity correlation or likelihood of language interference. Only the bipolar stimulation correlation remained significant following separate analysis of the bipolar and monopolar methods.</p><p><strong>Conclusions: </strong>These findings suggest that intraoperative threshold-based electrical mapping can feasibly assess language tract proximity, supporting maximal tumor resection while minimizing language deficits.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":3.5,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030252","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 neuronal reserve in glioma surgery: functional reorganization of the motor network examined by navigated transcranial magnetic stimulation and diffusion tensor imaging tractography.","authors":"Fabia Roth, Leona Kawelke, Thomas Picht, Peter Vajkoczy, Anna Zdunczyk","doi":"10.3171/2025.1.JNS241103","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241103","url":null,"abstract":"<p><strong>Objective: </strong>Patients suffering from rolandic gliomas are differently affected by motor deficits due to the lesion growth and edema as well as the surgical intervention. One reason for the different dynamics of disease progression and surgical outcome might be an individual potential for compensation and adaptation of the motor network. The aim of the present study was therefore to investigate the reorganization capacity of the motor cortex in patients with glioma by using navigated transcranial magnetic stimulation and diffusion tensor imaging tractography.</p><p><strong>Methods: </strong>The cortical motor representation area of the first dorsal interosseous muscle was mapped preoperatively on both hemispheres in 27 patients suffering from glioma (WHO grade ≥ II) in the primary or secondary motor cortex and in 17 follow-up patients (median 7 [IQR 6.5, 8.5] months after surgery). Twenty-eight healthy volunteers served as the control group. Motor function was evaluated based on the British Medical Research Council scale. Corticospinal excitability was determined by the resting motor threshold (RMT) and recruitment curve, and the cortical representation by mapping of the motor area with 105% RMT. Intracortical inhibition was reflected by the cortical silent period. The corticospinal tract integrity was determined by diffusion tensor imaging tractography including fractional anisotropy and apparent diffusion coefficient.</p><p><strong>Results: </strong>A motor paresis was preoperatively seen in 47% of the patients, which diminished to 23% at follow-up. The preoperatively observed RMT difference between the hemispheres diminished after 7 months (p < 0.05). An increased cortical excitability at follow-up was also indicated by less cortical inhibition (p < 0.05). A preoperatively small motor area size, excitability, and volume increased the risk for postoperative motor deficit (p < 0.05). Corticospinal tract disintegrity was associated with motor impairment (p < 0.05). Motor area reshaping expressed by a hotspot and center of gravity relocation could be observed in patients recovering from a motor deficit (p < 0.0001).</p><p><strong>Conclusions: </strong>This study confirmed prior findings on glioma-induced reorganization of primary motor areas. The association between functional recovery and reorganization, especially resizing and excitability changes, suggests an individual neuronal reserve explaining differences in disease progression. The authors support the extended consideration of navigated transcranial magnetic stimulation data for preoperative risk stratification and patient-tailored treatment strategies.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030173","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":"Spheno-orbital meningiomas: predictors of recurrence and novel strategies for surgical management.","authors":"Edoardo Porto, Giovanni Carone, Giorgio Fiore, Massimiliano Del Bene, Tommaso Galbiati, Arianna Barbotti, Ignazio G Vetrano, Luca Mattei, Alessandro Perin, Francesco Prada, Federico Legnani, Cecilia Casali, Andrea Saladino, Francesco DiMeco","doi":"10.3171/2025.1.JNS241846","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241846","url":null,"abstract":"<p><strong>Objective: </strong>Spheno-orbital meningiomas (SOMs) represent approximately 2%-9% of tumors affecting the sphenoid wings. The main challenge in treating these meningiomas is achieving gross-total resection (GTR) due to the hyperostosis, which is pathognomonic. This study explored potential correlations between the recurrence rate of SOM and the extent of resection (EOR) of both the bony tumor portion (BTP) and soft tumor portion (STP). Additionally, it analyzed the progression-free survival (PFS) of SOM patients in relation to the EOR, adjuvant treatments, and other recognized risk factors, including demographic, clinical, and radiological characteristics.</p><p><strong>Methods: </strong>This retrospective study included a consecutive series of patients surgically treated for SOM at a single institution between 2011 and 2021. Demographic and clinical data were gathered from institutional medical records. Preoperative and postoperative brain CT and MRI scans were analyzed, with the STP and BTP identified and segmented based on their radiological characteristics. PFS was assessed using the Kaplan-Meier method, considering treatment options at recurrence (stereotactic radiosurgery [SRS] versus surgery) and applying the Youden index to determine the optimal residual STP volume cutoff.</p><p><strong>Results: </strong>The study cohort included 89 patients diagnosed with SOM, with a female-to-male ratio of 8.9:1. The average follow-up period was 78 months. Sixty percent of the patients had a history of contraceptive use for more than 10 years. While no significant correlation was found between postoperative BTP volume and recurrence (p > 0.05), a significant correlation was observed for the STP (p < 0.001). The recurrence rate after the initial surgery was 22.5%, with 20% of those patients undergoing a second surgery and 80% treated with SRS. Only 3.4% of patients required three treatments throughout the follow-up. Patients with a postoperative STP volume greater than 3.7 mm3 had an adjusted OR of 1.342 for recurrence risk (p < 0.001) and shorter progression-free survival (p = 0.049).</p><p><strong>Conclusions: </strong>This study suggests that achieving a safe maximal resection of the STP might help lower the recurrence rate of SOM, whereas this does not appear to apply to the BTP. Overall, the surgical approach for SOM should be tailored to prioritize maximal resection of the STP. Conversely, removal of the BTP should be tailored based on neurological deficits caused by direct compression of the orbit or venous congestion.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971940","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":"Predictive models for assessing the risk of brain aneurysm rupture.","authors":"Elena Sagues, Andres Gudino, Carlos Dier, Navami Shenoy, Diego Ojeda, Linder Wendt, Samantha Saenz Hinojosa, Emily Garces, Ivonne Salinas, Connor Aamot, Mario Zanaty, Santiago Ortega-Gutierrez, David Hasan, Edgar A Samaniego","doi":"10.3171/2025.1.JNS241772","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241772","url":null,"abstract":"<p><strong>Objective: </strong>Increased contrast enhancement of the aneurysm wall may indicate aneurysm instability. The authors tested different predictive models of aneurysm instability on a cohort of patients imaged with high-resolution magnetic resonance imaging (HR-MRI).</p><p><strong>Methods: </strong>Patients with intracranial aneurysms were prospectively scanned with HR-MRI. Aneurysm instability was defined as rupture or symptomatic status at presentation. Magnetic resonance images were analyzed, and 3D enhancement maps were generated to analyze aneurysm wall enhancement. Additionally, radiomics features were extracted from the aneurysm wall. Four different predictive models combining clinical patient information, morphological aneurysm metrics, wall enhancement, and radiomics data were created to compare their performance in predicting symptomatic aneurysm presentation.</p><p><strong>Results: </strong>A total of 129 intracranial aneurysms were included, with 34 (26%) being ruptured or symptomatic at presentation. The clinical model utilizing clinical variables and based on the Population, Hypertension, Age, Size of aneurysm, Earlier subarachnoid hemorrhage of another aneurysm, and Site of aneurysm (PHASES) score achieved an area under the curve (AUC) of 0.62 (70% accuracy, 44% sensitivity, and 79% specificity) in detecting symptomatic aneurysms. The combined model with the PHASES score and morphological aneurysm information (size ratio) improved the AUC to 0.79 (73% accuracy, 77% sensitivity, and 72% specificity). Adding aneurysm wall enhancement metrics further enhanced the model's performance, raising the AUC to 0.82 (81% accuracy, 65% sensitivity, and 86% specificity). The best performing model achieved an AUC to 0.87 (76% accuracy, 88% sensitivity, and 72% specificity) and included age and radiomic data.</p><p><strong>Conclusions: </strong>The triage process for aneurysms is highly personalized and can benefit from incorporating clinical data, detailed morphological metrics of the aneurysm, and sophisticated analyses of aneurysm wall enhancement such as radiomics.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022574","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":"Understanding the role of standardized letters of recommendation in reducing gender bias for applicants to the neurosurgery match 2020.","authors":"Caitlin A Payne, Dominique Fontaine, Jennifer Hong","doi":"10.3171/2025.1.JNS231903","DOIUrl":"https://doi.org/10.3171/2025.1.JNS231903","url":null,"abstract":"<p><strong>Objective: </strong>Women are underrepresented in neurosurgical training, with progressively fewer women in successive ranks. Letters of recommendation (LORs) are crucial for granting residency interviews, but data suggest they are biased by the applicant's gender, with women applicants receiving lower-quality letters. This study examines whether the standardized LOR (SLOR) format, introduced in the 2020 neurosurgery match, reduces gender bias.</p><p><strong>Methods: </strong>The authors reviewed Electronic Residency Application Service applications submitted to a single neurosurgery training program in 2020. LORs were separated by applicant gender and subjected to quantitative linguistic analysis using a custom MATLAB script. LORs were assessed for length, classification as letters of minimal assurance, and gendered stereotypic adjectives. An LOR provides an overall assessment of a candidate's potential and typically includes a description of the writer's relationship to the applicant, a description of intent as demonstrated by the record of the applicant, and a review of the applicant's accomplishments. Omission of any of these three components gives the reader only a partial grasp of a candidate's qualifications, resulting in a letter of minimal assurance. Gendered stereotypic adjectives are the result of a significant body of research devoted to analysis of gender differences in language. These adjectives fall within five word groups: standout, ability, research, grindstone, and teaching, with the latter two categories more often being used to describe females. SLORs were analyzed by noting the percentile ranking in each category. United States Medical Licensing Examination Step 1 scores were compared. Univariate analysis was performed for each LOR variable, using two-tailed t-tests. The distribution of SLOR percentile rankings was evaluated using a Kolmogorov-Smirnov test. A p value < 0.05 was considered significant. Lastly, match outcome data were analyzed to assess impact on outcome.</p><p><strong>Results: </strong>The authors reviewed 910 narrative LORs (NLORs) and 566 SLORs. Of the applicants, 71% were male and 29% were female. There were no significant differences in LOR length, total letters per applicant, or Step 1 scores by gender. Female applicants were more likely to have received letters of minimal assurance (5% vs 1%) and be described by teaching words (p = 0.0038). This difference persisted when evaluating narrative portions from SLORs alone. There were no differences in percentile rankings or match rates.</p><p><strong>Conclusions: </strong>Women receive more letters of minimal assurance and are more likely to be described with teaching words in NLORs, indicating a gender bias. Whether this influences match outcome is difficult to determine based on poor match data, but the present research suggests it does not. Nevertheless, SLORs may help to reduce the identified narrative bias.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015852","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}