Journal of neurosurgery最新文献

{"title":"Implantation of autologous peripheral nerve tissue to the nucleus basalis of Meynert in patients with Parkinson's disease during deep brain stimulation surgery: a 2-year report of safety, feasibility, and clinical response.","authors":"Sheliza Ali, Jorge E Quintero, Mallory Richert, Lisa Koehl, Amelia J Anderson-Mooney, Julie A Gurwell, Katherine S Manning, Saad Hulou, Thomas Hines, John T Slevin, Greg A Gerhardt, Frederick A Schmitt, Craig G van Horne","doi":"10.3171/2026.3.JNS251474","DOIUrl":"10.3171/2026.3.JNS251474","url":null,"abstract":"<p><strong>Objective: </strong>Parkinson's disease (PD) is characterized by both motor and nonmotor symptoms, including cognitive impairment. Neuronal loss in the nucleus basalis of Meynert (NBM) plays a role in the presentation of cognitive impairment in PD. The implantation of peripheral nerve tissue (PNT) might provide neuroprotective and regenerative capabilities and has shown promising open-label outcomes. The aim of this study was to investigate the safety, feasibility, and clinical outcomes of implanting PNT to the NBM in patients with PD.</p><p><strong>Methods: </strong>Seven participants with PD underwent bilateral deep brain stimulation (DBS) electrode implantation to the globus pallidus internus plus unilateral PNT regenerating sural nerve graft to the NBM. Participants were monitored at 6-month intervals postoperatively. Clinical outcome measures included neuropsychological, motor, nonmotor, and quality of life ratings.</p><p><strong>Results: </strong>All participants completed the 6- and 12-month visits and 5 completed the 24-month visit. There were no serious adverse events related to the study intervention. Neuropsychological performance results were similar to those of patients who underwent DBS standard-of-care procedures without graft implantation. Motor and quality of life ratings were slightly worse, with slight improvements in overall nonmotor scores.</p><p><strong>Conclusions: </strong>Unilateral implantation of PNT to the NBM was determined as a safe and feasible procedure such that it did not substantially increase the risk for cognitive decline and dementia beyond rates typically observed in late-stage PD. The current study targeted the NBM, an area not associated with motor symptoms, and the mild progression of motor and quality of life ratings suggest that PNT support might have target-specific clinical effects. These findings support the need for further research in this area, including larger studies that use appropriate control groups.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13499603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic endonasal approach for adrenocorticotropic hormone-producing pituitary neuroendocrine tumor causing Cushing's disease: multicenter retrospective study on 162 patients with early postoperative cortisol assessment.","authors":"Ilaria Bove, Jacopo Berardinelli, Robert Grady Briggs, Alexander Micko, John D Carmichael, Annamaria Colao, Stefan Wolfsberger, Domenico Solari, Gabriel Zada, Luigi Maria Cavallo","doi":"10.3171/2026.3.JNS252724","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252724","url":null,"abstract":"<p><strong>Objective: </strong>Cushing's disease (CD) is a severe endocrine disorder that remains difficult to treat. The first-line treatment for confirmed CD is selective pituitary adenoma resection. Postoperative hormonal remission may not be achieved, though, despite surgical intervention. Effective postoperative monitoring of the hormonal response in CD remains challenging.</p><p><strong>Methods: </strong>A multicenter observational retrospective cohort study was conducted including 162 patients with CD who underwent endoscopic endonasal resection from January 2007 to September 2021. Three institutions from the United States and Europe participated: University of Southern California, University of Naples Federico II, and Medical University of Vienna. Clinical information including age, sex, preoperative serum and urinary free cortisol levels, imaging findings, histopathological examination including immunohistochemical results, postoperative endocrinological results, and time to follow-up were reported.</p><p><strong>Results: </strong>Data were reviewed for 162 patients with biochemically confirmed CD undergoing surgery via an endoscopic endonasal approach. Morning cortisol < 2 µg/dL or < 5 µg/dL during the first 3 postoperative days (PODs) was associated with lower odds of recurrence (for < 2 µg/dL: OR 0.08, 95% CI 0.004-0.38 [p = 0.01]; for < 5 µg/dL: OR 0.25, 95% CI 0.09-0.61 [p = 0.003]). However, when comparing the two cutoff values (< 2 µg/dL and < 5 µg/dL), a trend toward increased risk was observed in patients with higher cortisol levels, although the difference was not statistically significant (OR 2.1, 95% CI 0.59-7.81; p = 0.25).</p><p><strong>Conclusions: </strong>Early postoperative hypocortisolemia with cortisol levels < 5 µg/dL within the first 3 days after surgery is a strong predictor of long-term remission. A cortisol level < 2 µg/dL on POD 1 was also significantly associated with a lower risk of recurrence, corresponding to a 91.8% recurrence-free survival rate with a mean follow-up of 29.8 ± 28.7 months.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Functional MRI of DBS using monopolar stimulation: contextualizing recent phantom findings.","authors":"Aaron Loh, Garene A Matossian, Brendan Santyr, Afis Ajala, Radhika Madhavan, Jürgen Germann, Gavin Elias, Renato P Munhoz, Alfonso Fasano, Amgad Louka, Benson Yang, Robert Jech, Ileana Hancu, Marisa DiMarzio, Julie G Pilitsis, Simon J Graham, Benjamin Davidson, Kamil Uludag, Mojgan Hodaie, Suneil K Kalia, Luka Milosevic, Ian R O Connell, Sriranga Kashyap, Andres M Lozano, Alexandre Boutet","doi":"10.3171/2026.4.JNS26766","DOIUrl":"10.3171/2026.4.JNS26766","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1255-1259"},"PeriodicalIF":3.8,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760635","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":"Intracranial dural arteriovenous fistulas with perimedullary venous drainage: analysis of the multinational CONDOR registry.","authors":"Adriaan R E Potgieser, Hana Hallak, Michelle Connor, Jane Yuan, Diogo P Moniz Garcia, Giuseppe Lanzino, Louis J Kim, Michael R Levitt, Minako Hayakawa, Edgar A Samaniego, Ali Alaraj, Robert M Starke, Adib A Abla, Matthew Koch, Abeer Dagra, Jason P Sheehan, Colin P Derdeyn, Bradley A Gross, Junichiro Satomi, Yoshiteru Tada, Diederik O Bulters, Sayied Abdol Mohieb Hosainey, Rose Du, Michael T Lawton, Isaac Josh Abecassis, Dale Ding, Sepideh Amin-Hanjani, Quang Nguyen, Joshua W Osbun, Gregory J Zipfel, J Marc C van Dijk","doi":"10.3171/2026.2.JNS252734","DOIUrl":"https://doi.org/10.3171/2026.2.JNS252734","url":null,"abstract":"<p><strong>Objective: </strong>Cognard type V dural arteriovenous fistulas (dAVFs), defined by spinal perimedullary venous drainage, represent a rare and aggressive neurovascular pathology. Comprehensive multicenter data remain scarce. The authors present the largest multicenter analysis to date, characterizing presentation, radiology, treatment, complications, and functional outcomes of Cognard type V dAVFs.</p><p><strong>Methods: </strong>The authors retrospectively analyzed patients with angiographically confirmed Cognard type V dAVFs from the Consortium for Dural Arteriovenous Fistula Outcomes Research (CONDOR), spanning 16 academic centers. Patient demographics, imaging features, treatment strategies, procedural complications, and modified Rankin Scale (mRS) scores were recorded.</p><p><strong>Results: </strong>Among 1077 patients with dAVFs, 37 (3%) had Cognard type V lesions. The mean patient age was 57 years, and 59.5% of patients were male. Most presented with nonhemorrhagic neurological deficits (68%), while 14% had hemorrhage. The most common location was the foramen magnum (32%). Embolization was the primary treatment in 67% of cases, complete obliteration was achieved in 71% of cases. Upfront microsurgery was performed in 22% of patients (obliteration rate 88%), and radiosurgery in 14% (success rate 40%). Salvage treatment further improved obliteration outcomes. Temporary complications occurred in 8% of patients (3/37): 2 with transient neurological deficits postembolization and 1 with transient hydrocephalus after surgery. Permanent complications were observed in 3% (1/37) due to treatment-related hemorrhage. At the last follow-up (mean 2.4 years), 69% (24/35) of patients maintained or improved to an mRS score ≤ 2. No deaths occurred. Functional improvement was seen in 29% (10/35), while mRS decline was in 40% of patients (14/35), all unrelated to the dAVF itself.</p><p><strong>Conclusions: </strong>Cognard type V dAVFs carry a high risk of neurological morbidity. However, favorable functional outcomes are achievable with timely, multimodal intervention. Complication rates remain low, with most being transient. These data support aggressive but tailored management to prevent permanent disability in this high-risk population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689147","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 role of stereotactic radiosurgery in the management of vestibular schwannoma in octogenarians: an international multi-institutional study.","authors":"Hussam Abou-Al-Shaar, Ibrahem Albalkhi, Othman Bin-Alamer, Jeffery R Head, Arka N Mallela, Rodney E Wegner, Trent Kite, Sean S Mahase, Kara Nolan, Brad E Zacharia, David Bailey, Cheng-Chia Lee, Huai-Che Yang, Greg N Bowden, Bardia Hajikarimloo, Michelle Lin, Cheng Yu, Eric Chang, Christian Amezquita-Contreras, Angel I Blanco, Yoshua Esquenazi, Pavnesh Kumar, Joshua D Palmer, Andrea Franzini, Piero Picozzi, Pietro Paolo Cotrufo, Keiss Douri, David Mathieu, Patrick Grover, Simon C Williams, Siddharth Sinha, Charlotte Comon, Arif Jalal, Nazir Sirajudeen, Mark Markov, Türker Kılıç, Rovshan Rustamov, Deniz Kılıç, Paul M Harary, Yusuke S Hori, David J Park, Steven D Chang, Ali Haluk Düzkalir, Selcuk Peker, Dušan Urgošík, Roman Liščák, Ronald E Warnick, Manjul Tripathi, Rajkumar Bhatta, Narendra Kumar, Anais Andrade, Monica Mureb, Kenneth Bernstein, Nuria Martínez Moreno, Roberto Martínez-Álvarez, Gabriel Zada, Jason P Sheehan, Douglas Kondziolka, Ajay Niranjan, Constantinos G Hadjipanayis, L Dade Lunsford","doi":"10.3171/2026.2.JNS252486","DOIUrl":"https://doi.org/10.3171/2026.2.JNS252486","url":null,"abstract":"<p><strong>Objective: </strong>The incidence of vestibular schwannoma (VS) diagnosis among octogenarians has increased due to longer life expectancy and greater MRI accessibility and utilization. Stereotactic radiosurgery (SRS) offers a safe management strategy for these patients.</p><p><strong>Methods: </strong>The authors retrospectively analyzed the data of octogenarians with VS managed with SRS across 27 institutions, assessing clinical and audiological outcomes, including survival rates, tumor control responses, complications, and posttreatment functional outcomes.</p><p><strong>Results: </strong>Among 309 octogenarians with VS managed with single-fraction SRS, overall survival was 97.8% at 1 year, 88.5% at 3 years, and 78.1% at 5 years; the corresponding progression-free survival rates were 95.8%, 81.1%, and 71.1%, respectively. In competing risk analysis, tumor progression occurred in 5.2% of patients by 5 years, whereas death without progression reached 19.8%. Tumor control was achieved in 94.8% at 3 and 5 years. At last imaging follow-up (median 33.5 months, IQR 14-60 months), 29.1% showed volume regression. Communicating hydrocephalus developed in 4.2% and was successfully managed with CSF diversion. Age, sex, tumor volume, Koos grade, and margin dose were not significant predictors of patient survival or tumor progression.</p><p><strong>Conclusions: </strong>Single-fraction SRS is a safe and effective management modality for octogenarians with VS, providing durable tumor control with minimal morbidity.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689125","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":"Surgical management of facial nerve schwannomas: a contemporary series of 67 surgeries.","authors":"Ken Matsushima, Michihiro Kohno, Nobuyuki Nakajima, Norio Ichimasu, Masanori Yoshino, Taro Inagaki, Kiyoaki Tsukahara","doi":"10.3171/2026.3.JNS252831","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252831","url":null,"abstract":"<p><strong>Objective: </strong>Facial nerve schwannomas (FNSs) are rare benign tumors that can involve any segment of the facial nerve. Comprehensive understanding of these tumors remains limited, largely due to the paucity of reports on large surgical series in the literature, and their clinical management is particularly challenging. To balance tumor control with favorable facial nerve function, the authors have adopted nerve-preserving surgery (nonradical tumor removal and bony decompression) for moderate facial nerve palsy and conventional nerve reconstruction surgery (total tumor removal and facial nerve reconstruction) for severe or complete palsy cases. In this study, the authors evaluate the utility of a function-centered surgical strategy and a five-category, location-based classification system, based on a relatively large contemporary series.</p><p><strong>Methods: </strong>A total of 67 consecutive FNS surgeries performed in 61 patients between 2004 and 2022 were retrospectively reviewed. The surgical strategy was selected according to the patient's preoperative facial nerve function and intraoperative electromyography (EMG) responses.</p><p><strong>Results: </strong>Nerve-preserving surgery was performed in 47 cases (70.1%) and was associated with improved or stable facial nerve function in 87.2%. The mean House-Brackmann grade improved from 3.5 to 3.0 in the nerve preservation group and from 4.6 to 4.0 in the nerve reconstruction group. Overall, facial nerve function improved in 50.7% and worsened in 13.4% of cases. In the nerve preservation group, tumors confined within the temporal bone (intrameatal, tympanic, and mastoid types), younger age, and favorable EMG responses were associated with better postoperative facial nerve function. During long-term follow-up (mean 87.2 months), 27.7% of this group required additional treatment.</p><p><strong>Conclusions: </strong>A function-centered strategy, supported by intraoperative EMG monitoring and a tumor-centered classification, enables selective nerve preservation and was associated with favorable outcomes in FNS surgery. This strategy may serve as a practical framework for individualized surgical treatment of FNSs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689219","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":"Metabolic boundary resection of glioblastoma correlates with clinical outcome and survival analysis: a comparative cohort study.","authors":"Wenchao Lu, Yang Liu, Xiao Wu, Longxiang Ma, Hui Ma","doi":"10.3171/2026.3.JNS252582","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252582","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to investigate the impact of 3D 1H-MR spectroscopy (MRS)-guided metabolic boundary resection (MBR) on the extent of resection (EOR), surgical safety, and prognosis in glioblastoma.</p><p><strong>Methods: </strong>A retrospective analysis was performed on clinical data from patients with IDH-wildtype glioblastoma who underwent resection at the authors' hospital. Patients were divided into two groups based on surgical methods: the traditional boundary resection (TBR) group (neuronavigation + contrast-enhancing [CE] boundary resection) and the MBR group (3D 1H-MRS combined with neuronavigation + MBR). Demographic, perioperative, and follow-up data were collected and compared between the two groups. Cox proportional hazards regression and Kaplan-Meier survival analysis were used to evaluate the effects of various clinical and treatment-related factors on patient survival.</p><p><strong>Results: </strong>The MBR group included 41 patients (mean age 54.17 ± 12.04 years, 65.85% male) with a mean tumor volume of 58.07 ± 20.63 cm3. The TBR group included 30 patients (mean age 56.86 ± 9.78 years, 63.33% male) with a mean tumor volume of 52.51 ± 24.06 cm3. There were no statistically significant differences between the two groups in tumor laterality, location, volume, and length of hospital stay. In the TBR group, 10 patients achieved supra-total resection (SpTR), 13 achieved gross-total resection (GTR), and 7 achieved subtotal resection (STR). In the MBR group, 25 patients achieved SpTR, 10 achieved GTR, and 6 achieved STR. The rate of SpTR was significantly higher in the MBR group compared to the TBR group (p = 0.021). Postoperative neurological deficits occurred in 1 patient (2.4%) in the MBR group (transient) and 2 patients (6.7%) in the TBR group (1 permanent). No significant difference in complication rates was observed (p = 0.369). Kaplan-Meier survival analysis and log-rank tests demonstrated that the MBR group had significantly longer progression-free survival (PFS) and overall survival (OS) compared to the TBR group (p < 0.001). Multivariable Cox proportional hazards regression analysis identified EOR and surgical methods as independent prognostic factors.</p><p><strong>Conclusions: </strong>Three-dimensional 1H-MRS combined with a neuronavigation system is used to guide glioblastoma resection along the metabolic boundary during surgery, which can lead to a more complete resection of the glioblastoma and improve the PFS and OS of patients. Compared to CE boundary resection, MBR appears to be a stronger prognostic factor for survival.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689213","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":"Prediction of cerebral hyperperfusion syndrome in adults with moyamoya disease after combined bypass surgery using perioperative hemodynamic and blood pressure changes.","authors":"Weihua Zhong, Yanhong Yan, Bai Zhang, Yusen Liu, Jia Yang, Yabo Huang, Pinjing Hui","doi":"10.3171/2026.2.JNS252708","DOIUrl":"https://doi.org/10.3171/2026.2.JNS252708","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral hyperperfusion syndrome (CHS) represents a significant complication following superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery for moyamoya disease (MMD), characterized by the onset of various neurological symptoms. The aim of this study was to explore the predictive role of perioperative hemodynamic parameters and blood pressure (BP) in postoperative CHS among adult patients with MMD who undergo STA-MCA bypass surgery.</p><p><strong>Methods: </strong>This study included 284 hemispheres from 218 patients with MMD who underwent STA-MCA bypass surgery. Perioperative hemodynamics were monitored using carotid Doppler ultrasound (CDU) and microprobe-vascular Doppler (MVD), assessing the recipient proximal M4 segment of the middle cerebral artery (pM4) and donor STA parietal branch parameters, with simultaneous perioperative BP monitoring. Patients are divided into the CHS group and non-CHS groups according to whether CHS occurred. Univariate and multivariate logistic regression identified CHS predictors, supplemented by correlation analysis of post/preanastomosis (post/preanast) fold increase in pM4 mean flow velocity (MFV) versus the postoperative/preoperative (post/preop) regional cerebral blood flow (rCBF) ratio and longitudinal hemodynamic comparisons of STA.</p><p><strong>Results: </strong>CHS occurred in 72 hemispheres (25.4%), with 212 classified as non-CHS. Multivariate analysis identified 3 independent CHS predictors: pM4 MFV post/preanast fold increase > 8.8 (OR 1.37, 95% CI 1.18-1.59), systolic blood pressure (SBP) on postoperative day (POD) 1 > 127 mm Hg (OR 1.13, 95% CI 1.07-1.19), and time-averaged peak velocity (TAPV) of STA on POD 3 > 66 cm/sec (OR 1.02, 95% CI 1.00-1.05). The combined model demonstrated superior accuracy (area under the curve 0.88, 95% CI 0.85-0.94, p < 0.001) with 80.6% sensitivity/84.9% specificity. pM4 MFV post/preanast fold increase strongly correlated with rCBF post/preop ratio in the CHS group (r = 0.8782, p < 0.001). Both groups showed increased STA diameter, TAPV, and time-averaged mean velocity (TAMV) after surgery, with CHS patients having greater TAPV and TAMV at POD 3 (p < 0.001).</p><p><strong>Conclusions: </strong>Intraoperative pM4 MFV post/preanast fold increase > 8.8, POD 1 SBP > 127 mm Hg, and POD 3 STA TAPV > 66 cm/sec were potential risk factors for postoperative CHS in adults with MMD. Therefore, postoperative management in these cases must be approached with heightened vigilance.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689222","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":"Non-O blood groups as independent predictors of chronic subdural hematoma recurrence in antithrombotic-naive patients: risk mitigation by prior aspirin use and new perspectives for stratification.","authors":"Schahin Salmanian, Jan Rodemerk, Sali Al-Rubaiey, Madiha Ahmadzai, Elias Timner, Thiemo Florin Dinger, Oliver Gembruch, Ramazan Jabbarli, Philipp Dammann, Ulrich Sure, Mehdi Chihi","doi":"10.3171/2026.2.JNS252663","DOIUrl":"https://doi.org/10.3171/2026.2.JNS252663","url":null,"abstract":"<p><strong>Objective: </strong>Recurrence after surgical treatment of chronic subdural hematoma (CSDH) remains insufficiently understood. Microvascular pathology of the CSDH membrane is a suspected driver of this recurrence, supported by reduced recurrence following middle meningeal artery embolization. Given the known differences in clotting propensity among ABO blood groups and the frequent use of antiplatelet and/or anticoagulant therapy (AAT) in the CSDH population, this study aimed to investigate the impact of ABO blood groups on postoperative recurrence risk.</p><p><strong>Methods: </strong>The authors conducted a retrospective analysis of patients with symptomatic CSDH who underwent surgery at their institution between June 2012 and December 2023. Prior AAT was discontinued at hospital admission and reinitiated 3 weeks postoperatively, if CSDH resolution was complete. Recurrence was defined as an episode of radiological hematoma progression, with or without the development of symptoms, that required reoperation.</p><p><strong>Results: </strong>A total of 756 patients with surgically treated CSDH (mean age 75.1 [SD 11.9] years, female-to-male ratio 1:2.1) were included. In patients without prior AAT use (n = 360), univariate analysis showed that non-O blood groups had significantly higher recurrence rates than blood group O (19.4% vs 8.7%, p = 0.006). Multivariate analysis confirmed non-O (p = 0.002, adjusted odds ratio [aOR] 3.5), and particularly A (p < 0.001, aOR 5.1), blood groups were independent predictors of recurrence. Comparing patients with prior acetylsalicylic acid (aspirin) use (n = 190) with those without prior AAT use, univariate analysis revealed that prior aspirin therapy was associated with a significantly lower recurrence rate among non-O (6.9% vs 19.4%, p = 0.002), and particularly A (8% vs 21%, p = 0.011), blood groups. Multivariate analysis identified prior aspirin use in non-O (p = 0.004, aOR 0.284), and particularly A (p = 0.015, aOR 0.324), blood groups as an independent predictor of reduced recurrence.</p><p><strong>Conclusions: </strong>This large-scale study demonstrated that non-O blood groups, and particularly A blood groups, are independent predictors of increased CSDH recurrence in patients without prior AAT use. These findings support the development of a scoring system based on blood groups, particularly for patients with groups A and O, to improve recurrence risk stratification and to tailor treatment plans. In contrast, prior aspirin use in these groups was an independent predictor of markedly reduced recurrence rates, comparable to those of blood group O.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor. Methodological concern regarding assessment timing in the study of cognitive outcomes after aSAH.","authors":"Feng Zhou, Shuangxiang Xu, Hao Chen","doi":"10.3171/2026.4.JNS26820","DOIUrl":"10.3171/2026.4.JNS26820","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1259-1261"},"PeriodicalIF":3.8,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689169","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}