Journal of neurosurgery最新文献

{"title":"Intraosseous needle for management of subacute and chronic subdural hematoma.","authors":"Navraj Heran, Tyler D Yan, Manraj K S Heran, Amir Behboudi, Susan K Kadyschuk","doi":"10.3171/2025.1.JNS241265","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241265","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study was to evaluate the safety and efficacy of using an intraosseous (IO) needle for decompressive management of subacute and chronic subdural hematomas (SDHs).</p><p><strong>Methods: </strong>This is a single-center retrospective review of subacute and chronic SDHs treated with IO needle decompression from May 2022 to November 2023. Technical success, recurrence, procedure-related complications, major adverse events, patient demographics, and procedural details were analyzed using standard statistical analysis.</p><p><strong>Results: </strong>Fifty-one patients (mean age 75.4 [SD 11.4] years) met the inclusion criteria. Technical success was achieved in all patients, with only 1 case of recurrence. Rates of procedure-related complications (3/51, 5.9%) and major adverse events (2/51, 4%) were low. There were no statistically significant differences between those with subacute SDHs compared with those with chronic SDHs.</p><p><strong>Conclusions: </strong>IO needle decompression is a feasible, safe, and effective option for management of subacute and chronic SDHs, with minimal recurrence.</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":"143986729","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. Ensuring equitable access to neurosurgical careers.","authors":"Muzammil Arif Din Abdul Jabbar, Iqra Shiekh","doi":"10.3171/2024.12.JNS243114","DOIUrl":"https://doi.org/10.3171/2024.12.JNS243114","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022570","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. Considerations for refractory trigeminal neuralgia after MVD.","authors":"Colby T Joncas, Guy M McKhann, Raymond F Sekula","doi":"10.3171/2024.12.JNS243196","DOIUrl":"https://doi.org/10.3171/2024.12.JNS243196","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-3"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015828","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 Treatment of Penetrating Wounds After Resuscitation study: a new classification system for penetrating injuries to the posterior fossa.","authors":"Andrii Sirko, Jeffrey I Traylor, William H Hicks, Ghazal Yadav, Rocco A Armonda, Alex B Valadka","doi":"10.3171/2025.1.JNS242420","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242420","url":null,"abstract":"<p><strong>Objective: </strong>The goal of this retrospective study was to evaluate the new Surgical Treatment of Penetrating Wounds After Resuscitation (STOPWAR) posterior fossa penetrating traumatic brain injury (pTBI) classification scheme, which is based only on features of the projectile trajectory.</p><p><strong>Methods: </strong>This retrospective investigation evaluated a consecutive series of 71 patients with penetrating posterior fossa injuries who arrived at Mechnikov Dnipropetrovsk Regional Clinical Hospital in Dnipro, Ukraine, between February 24, 2022, and May 2, 2024. Univariable and multivariable analyses were performed to examine the relationships between STOPWAR classification and 1-month mortality as well as 1-month outcome on the dichotomized Glasgow Outcome Scale (GOS). Other classification and prognostic schemes for patients with traumatic brain injury (TBI) were also evaluated.</p><p><strong>Results: </strong>The 1-month mortality rate in this series was 21%. The STOPWAR classification scheme had an area under the receiver operating characteristic curve (AUC) of 0.9298 and OR of 4.054 (95% CI 2.287-9.126) for 1-month mortality and an AUC of 0.8373 and OR of 3.154 (95% CI 1.954-5.830) for 1-month dichotomized GOS outcome. This performance was comparable to that of the other TBI classification schemes that were evaluated.</p><p><strong>Conclusions: </strong>In the largest reported series of patients with posterior fossa pTBI, 1-month mortality was lower than that in other published series, suggesting that patients with military pTBI, which is caused primarily by shrapnel, may have a better outcome than those with civilian pTBI, most of whom have gunshot wounds. The STOPWAR classification system performed well. A major advantage of the STOPWAR scale is that it is based only on imaging findings and may be used when clinical examination is impossible or potentially inaccurate. The slightly worse performance of the STOPWAR scheme for GOS outcome than for mortality may reflect the inadequacy of using the GOS as an outcome metric at the early postinjury time point of 1 month. Unfortunately, more detailed outcome assessments at longer postinjury time intervals are currently not possible in Ukraine. These and other improvements in study design can be explored in future investigations, which may also evaluate the role of the STOPWAR scale in civilian pTBI patients and in casualties from other armed conflicts.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024925","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 features of Rathke's cleft cyst with secondary hypophysitis and outcomes of endoscopic transnasal surgery versus features of common Rathke's cleft cysts: a single-center retrospective cohort study.","authors":"Takuro Ehara, Noriaki Fukuhara, Shinji Ito, Mitsuo Okada, Hiroshi Nishioka","doi":"10.3171/2025.1.JNS24892","DOIUrl":"https://doi.org/10.3171/2025.1.JNS24892","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to examine the clinical characteristics of Rathke's cleft cyst (RCC) with secondary hypophysitis and compare them with the clinical characteristics of common RCC.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included cases of pituitary disease in which endoscopic transnasal surgery was performed from January 2011 to March 2023. Patients with RCC were identified, and secondary hypophysitis was subsequently identified based on pathological and MRI findings. Pathologically, the presence of lymphocytic infiltration into the normal anterior pituitary gland was used as a criterion for determining hypophysitis. On MRI, RCCs showing marked thickening of the cyst wall and pituitary stalk swelling ≥ 3.5 mm were considered as hypophysitis. A comparative study was performed at our institution using retrospectively collected data on RCCs with secondary hypophysitis and common RCCs.</p><p><strong>Results: </strong>The study included 11 patients with RCC with secondary hypophysitis (median age 36 years) and 95 patients with common RCC (median age 51 years). The proportions of patients with headache (90.9% vs 48.4%, p = 0.009), fever (63.6% vs 1.1%, p < 0.001), panhypopituitarism (90.9% vs 24.2%, p < 0.001), and diabetes insipidus (90.9% vs 21.1%, p < 0.001) were significantly higher in the RCC with secondary hypophysitis group than the common RCC group. Although reaccumulation rates and the time to reaccumulation did not differ between the groups, the operative rate when reaccumulation occurred was significantly higher in patients with RCC with secondary hypophysitis than in those with common RCC (75% vs 13%, p = 0.015).</p><p><strong>Conclusions: </strong>RCC with secondary hypophysitis was associated with a high incidence of headache, fever, panhypopituitarism, and diabetes insipidus. The reaccumulation rate and time to reaccumulation in the RCC with secondary hypophysitis group did not differ from those in the common RCC group; however, the operative rate at reaccumulation was extremely high for those with RCC with secondary hypophysitis, indicating the need for tailored management strategies. Future studies with larger sample sizes and refined criteria are essential to better understanding RCCs with secondary hypophysitis and to optimize therapeutic interventions.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022397","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":"Who has your back?","authors":"Amgad S Hanna","doi":"10.3171/2025.2.JNS254","DOIUrl":"https://doi.org/10.3171/2025.2.JNS254","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040493","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":"Global neurosurgery policy making and education: responsibilities and opportunities.","authors":"Ernest J Barthélemy, Souhil Tliba, Gail Rosseau, Anthony O Asemota, Michael C Dewan, Anthony A Figaji, Kee B Park, Anthony Asher, Isabelle M Germano","doi":"10.3171/2024.12.JNS241988","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241988","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012328","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":"Relationship of blood flow, angioarchitecture, and rupture in cerebral arteriovenous malformations.","authors":"Laura Stone McGuire, Tatiana Abou-Mrad, Peter Theiss, Jessica Hossa, Mpuekela Tshibangu, Adrusht Madapoosi, Fady T Charbel, Ali Alaraj","doi":"10.3171/2025.1.JNS241975","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241975","url":null,"abstract":"<p><strong>Objective: </strong>Cerebral arteriovenous malformations (AVMs) have a 2%-4% annual risk of intracranial hemorrhage. Understanding hemorrhage risk is crucial for determining appropriate treatment. The degree to which cerebral blood flow within AVMs interplays with angioarchitecture and contributes to potential rupture represents an active area of research. Prior studies have shown conflicting results; those based on quantitative MR angiography (QMRA) have found lower flow associated with hemorrhage, while those using angiography-determined transit time associated higher flow with rupture.</p><p><strong>Methods: </strong>A prospectively collected institutional database of 647 adult patients with cerebral AVMs (1995-2023) was queried. Patients with baseline QMRA studies were included in the analysis. Patient characteristics, angioarchitectural information, and hemodynamic data were collected for each patient and compared between those who presented with and those who presented without hemorrhage.</p><p><strong>Results: </strong>A total of 171 patients met the inclusion criteria; 105 patients had unruptured AVMs and 66 had ruptured AVMs at presentation. The mean age did not differ between groups (39.4 years vs 39.9 years), but there was male predominance in the rupture group (67.7%, p = 0.023). A deep AVM location was more likely in those with rupture (p = 0.002). The mean calculated AVM flow was lower in the rupture group (284.3 mL/min vs 401.8 mL/min, p = 0.013). Additionally, the mean AVM volume was smaller in the rupture group (8.8 cm3 vs 14.5 cm3, p = 0.040). The mean number of arterial feeders did not differ between groups (2.4 vs 2.4, p = 0.986), but the mean size of the largest feeder was smaller in those presenting with hemorrhage (2.6 vs 3.0 mm, p = 0.038). Furthermore, ruptured AVMs were more likely to have deep venous drainage (p = 0.007) and fewer draining veins (mean 1.9 vs 2.4, p = 0.020) than unruptured AVMs. The presence of feeder aneurysms, intranidal aneurysms, and nidal compactness did not differ between groups.</p><p><strong>Conclusions: </strong>Patients with baseline QMRA studies who presented with ruptured AVMs were noted to have a deep location, deep venous drainage, lower flow, smaller nidal volume, smaller arterial feeders, and fewer draining veins compared with those with unruptured AVMs. These findings validate results from smaller prior studies based on QMRA.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017942","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":"Robot-assisted versus manual frame-based stereoelectroencephalography.","authors":"Mahmoud Abdallat, Holger Joswig, Abdulrahman R Nazer, Muhammad Hammouri, Andrew G Parrent, Keith W MacDougall, Jorge G Burneo, David A Steven","doi":"10.3171/2025.1.JNS241118","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241118","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to retrospectively compare robot-assisted and manual frame-based stereoelectroencephalography (SEEG) with respect to timing, complications, and outcomes in a high-volume epilepsy surgery center.</p><p><strong>Methods: </strong>All patients with drug-resistant epilepsy who underwent SEEG from 2000 to 2020 were collected for a retrospective-and from 2017 onward, prospective-database.</p><p><strong>Results: </strong>A total of 192 SEEG procedures consisted of 88 robot-assisted and 104 manual frame-based cases. Both groups were of similar age, gender distribution, and duration of epilepsy. A mean of 10.9 electrodes were implanted for the robot-assisted group versus 9.3 electrodes in the manual frame-based group (p < 0.01) with a mean implantation time per electrode of 8.2 ± 3.4 versus 16.1 ± 7.7 minutes, respectively (p < 0.01). Complications were low in both groups; intracranial hemorrhage was observed in 6.8% and 5.8%, respectively.</p><p><strong>Conclusions: </strong>Using a stereotactic robot for SEEG electrode insertion can significantly decrease operative time.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029067","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":"Utility of artificial intelligence in radiosurgery for pituitary adenoma: a deep learning-based automated segmentation model and evaluation of its clinical applicability.","authors":"Martin Černý, Jaromír May, Lucie Hamáčková, Hana Hallak, Josef Novotný, Denis Baručić, Jan Kybic, Michaela May, Martin Májovský, Michael J Link, Neevya Balasubramaniam, Dalibor Síla, Miriam Babničová, David Netuka, Roman Liščák","doi":"10.3171/2024.12.JNS242167","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242167","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to develop a deep learning model for automated pituitary adenoma segmentation in MRI scans for stereotactic radiosurgery planning and to assess its accuracy and efficiency in clinical settings.</p><p><strong>Methods: </strong>An nnU-Net-based model was trained on MRI scans with expert segmentations of 582 patients treated with Leksell Gamma Knife over the course of 12 years. The accuracy of the model was evaluated by a human expert on a separate dataset of 146 previously unseen patients. The primary outcome was the comparison of expert ratings between the predicted segmentations and a control group consisting of original manual segmentations. Secondary outcomes were the influence of tumor volume, previous surgery, previous stereotactic radiosurgery (SRS), and endocrinological status on expert ratings, performance in a subgroup of nonfunctioning macroadenomas (measuring 1000-4000 mm3) without previous surgery and/or radiosurgery, and influence of using additional MRI modalities as model input and time cost reduction.</p><p><strong>Results: </strong>The model achieved Dice similarity coefficients of 82.3%, 63.9%, and 79.6% for tumor, normal gland, and optic nerve, respectively. A human expert rated 20.6% of the segmentations as applicable in treatment planning without any modifications, 52.7% as applicable with minor manual modifications, and 26.7% as inapplicable. The ratings for predicted segmentations were lower than for the control group of original segmentations (p < 0.001). Larger tumor volume, history of a previous radiosurgery, and nonfunctioning pituitary adenoma were associated with better expert ratings (p = 0.005, p = 0.007, and p < 0.001, respectively). In the subgroup without previous surgery, although expert ratings were more favorable, the association did not reach statistical significance (p = 0.074). In the subgroup of noncomplex cases (n = 9), 55.6% of the segmentations were rated as applicable without any manual modifications and no segmentations were rated as inapplicable. Manually improving inaccurate segmentations instead of creating them from scratch led to 53.6% reduction of the time cost (p < 0.001).</p><p><strong>Conclusions: </strong>The results were applicable for treatment planning with either no or minor manual modifications, demonstrating a significant increase in the efficiency of the planning process. The predicted segmentations can be loaded into the planning software used in clinical practice for treatment planning. The authors discuss some considerations of the clinical utility of the automated segmentation models, as well as their integration within established clinical workflows, and outline directions for future research.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012311","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}