Journal of neurosurgery最新文献

{"title":"Development and validation of a nomogram for predicting symptomatic hemorrhage risk in sporadic cerebral cavernous malformations.","authors":"Yang Liu, Huan Kang, Zheng Wen, Jing Yuan, Li Ma, Shuo Zhang, Qingyuan Liu, Shuo Wang, Huan Fan, Jun Wu","doi":"10.3171/2026.2.JNS252142","DOIUrl":"https://doi.org/10.3171/2026.2.JNS252142","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop and externally validate a nomogram to predict individualized 5-year symptomatic hemorrhage risk in patients with sporadic cerebral cavernous malformations (CCMs).</p><p><strong>Methods: </strong>Patients diagnosed with sporadic CCMs who were enrolled in two prospective multicenter cohorts were analyzed. Independent predictors of symptomatic hemorrhage were identified through multivariate Cox regression analysis and integrated into a predictive nomogram. The nomogram's performance was assessed using the C-index, calibration curves, decision curves, and areas under the curve. Patients were stratified into high- and low-risk groups based on optimal nomogram cutoff scores.</p><p><strong>Results: </strong>The training cohort included 331 patients (173 female, mean age 39.1 years), and the external validation cohort included 57 patients (31 female, mean age 39.2 years). Multivariate Cox regression analysis identified previous hemorrhage (HR 2.66), lesion size > 1.5 cm (HR 2.89), concurrent developmental venous anomalies (HR 2.24), brainstem location (HR 4.04), and Zabramski type I lesions (HR 3.65) as independent predictors of symptomatic hemorrhage. The developed nomogram demonstrated strong predictive accuracy, with a C-index of 0.81 (95% CI 0.75-0.87) in the training cohort and 0.87 (95% CI 0.78-0.95) in the external validation cohort. Patients classified into the high-risk group (≥ 195 points) exhibited significantly higher hemorrhage risk compared with those in the low-risk group.</p><p><strong>Conclusions: </strong>The developed nomogram effectively integrates clinical and radiological factors to accurately predict individualized 5-year symptomatic hemorrhage risk in patients with sporadic CCMs, providing valuable support for personalized clinical decision-making.</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":"148689130","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 neurosurgeon at the fall of France in June 1940: the last days of Thierry de Martel (1875-1940).","authors":"Johan Pallud, Gonzague Defrance, Angela Elia, Jean-Paul Pallud, Anne-Sophie Savoureux, Christophe Joubert, Alexandre Roux, Marc Zanello","doi":"10.3171/2026.3.JNS252723","DOIUrl":"https://doi.org/10.3171/2026.3.JNS252723","url":null,"abstract":"<p><p>Thierry de Martel was a pioneer of French neurosurgery and a decorated World War I veteran. During World War II, he organized and modernized neurosurgical care for French soldiers at the American and Laennec Hospitals in Paris. As the German army advanced in June 1940, de Martel, aged 64, sought to join a last-ditch resistance effort. Disillusioned by France's military defeat and political collapse and burdened by the death of his only son in World War I, he took his own life on June 14, 1940, the day German troops entered Paris. This article reconstructs the final weeks of de Martel's life through archival materials, medical records, and eyewitness accounts, offering a unique historical perspective on the ethical, emotional, and professional dilemmas faced by physicians during wartime. De Martel's final act was both a protest and a legacy-a message of surgical precision, patriotic despair, and moral clarity. His story resonates today as a testament to the enduring tension between duty to life and devotion to country.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648612","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":"Navigating the atrium: leveraging the intraoccipital sulcus as a natural corridor for safe access. A sulcal and subcortical architectural analysis.","authors":"Lykourgos Anastasopoulos, Eirini Charalampopoulou, Eleftherios Neromyliotis, Evangelos Drosos, Georgios P Skandalakis, Aristotelis V Kalyvas, Theodore Troupis, Lampis C Stavrinou, Georgios Stranjalis, Christos Koutsarnakis","doi":"10.3171/2026.3.JNS252569","DOIUrl":"10.3171/2026.3.JNS252569","url":null,"abstract":"<p><strong>Objective: </strong>Lesions in or around the atrium pose a surgical challenge due to their deep location and proximity to eloquent cortical and subcortical structures. Hence, a handful of approaches have been proposed aiming to minimize parenchymal transgression while providing adequate surgical maneuverability and dexterity. To this end, the authors sought to evaluate, for the first time in the pertinent literature, the feasibility of the intraoccipital sulcus (IOS) as a natural corridor to access the atrium safely and effectively.</p><p><strong>Methods: </strong>Twenty formalin-fixed adult cerebral hemispheres treated with the Klingler's technique were investigated. The morphology of the IOS was recorded, and the subcortical anatomy lining the corridor from the sulcal fundus to the atrium was explored through focused lateromedial white matter dissections. Additionally, 20 T2-weighted multiplanar reconstructions (MPRs) from the HCP Young Adult dataset were analyzed to quantify the \"angle of attack\" toward the atrium. Then the respective distances of the IOS and intraparietal sulcus (IPS) from the midline were compared to evaluate whether an IOS-based trajectory permits access to the atrial roof rather than the lateral wall. T2-weighted MR images from a cohort of 25 healthy individuals were also included to record the IOS surface anatomy, sulcal length, and fundus-to-atrium depth.</p><p><strong>Results: </strong>The IOS was consistently recorded and found to be continuous with the IPS in most cases. Its mean length and depth were approximately 2.2 cm and 1.1 cm, respectively, and the mean sulcal fundus-to-atrium distance was 1.90 cm. MPR analysis showed that the anterior IOS segment offers an almost perpendicular trajectory to the atrium and lies medial to the IPS, thus allowing entrance to the atrial roof. The white matter transgression en route to the ventricle disrupts the fibers of the vertical occipital fasciculus while causing minimal injury to the posterior part of the sagittal stratum. The approach avoids the optic pathway since it allows entering the atrium through its roof.</p><p><strong>Conclusions: </strong>An IOS transsulcal corridor provides a practical, safe, and effective pathway to the roof of the atrium as it minimizes transgression of eloquent fiber tracts and respects the optic radiations. Combined cadaveric and MRI evidence supports the IOS as a reliable planning landmark for selected atrial and periatrial lesions; however, prospective clinical validation is still needed.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1199-1207"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648573","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":"Single-stage retrosigmoid versus translabyrinthine resection of vestibular schwannomas: impact of tumor volume on surgical, functional, and radiological outcomes.","authors":"Ufuk Erginoglu, Bekir Can Kendirlioglu, Taha Sukru Korkmaz, Zeynep Arzum Uyaniker, Umid Sulaimanov, Cagdas Ataoglu, Irem Uslu, Gökce Hatipoglu Majernik, Abdullah Keles, Abdurrahman Aycan, Huseyin Erdem Ak, Joseph Roche, Mustafa K Baskaya","doi":"10.3171/2026.2.JNS252437","DOIUrl":"10.3171/2026.2.JNS252437","url":null,"abstract":"<p><strong>Objective: </strong>In this study, the authors aimed to compare surgical, functional, and radiological outcomes between retrosigmoid (RS) and translabyrinthine (TL) approaches for single-stage vestibular schwannoma (VS) resection, and to evaluate the influence of tumor volume (TV) and anatomical grade.</p><p><strong>Methods: </strong>The data of 283 patients (207 TL and 76 RS) who underwent single-stage resection between 2006 and 2023 were retrospectively reviewed. Outcomes included extent of resection (EOR), facial nerve (FN) function, hearing preservation, radiological findings, functional status (modified Rankin Scale [mRS] score), and hospital metrics. TV was analyzed as a continuous predictor alongside Koos grade. Multivariable regression and two propensity score-matched analyses were adjusted for confounders, including age, hearing status, and tumor burden. Collinearity between TV and Koos grade was excluded.</p><p><strong>Results: </strong>In Koos grade III and IV tumors, the TL group achieved higher gross-total resection/near-total resection (GTR/NTR; ≥ 95%) than the RS group (84.8% vs 69.6%, p = 0.019) and remained independently associated with improved EOR (adjusted OR [aOR] 4.76, 95% CI 1.74-13.00; p = 0.002), confirmed in propensity score matching. Larger TV was associated with a lower likelihood of GTR/NTR (aOR 0.12 per log-volume increase, p = 0.001). One-year FN preservation among patients with preoperative House-Brackmann (HB) grades I and II was comparable (94.7% for RS and 93.9% for TL; aOR 0.53, p = 0.34). Favorable discharge mRS score (scores 0-2) was more frequent in the TL group in Koos grade III and IV tumors (100% vs 91.1%) and remained independently associated (aOR 94.2, p = 0.010), although limited by quasi-complete separation. In the RS group, larger TV was significantly associated with worse mRS score (p = 0.001). Hearing preservation occurred only with the RS approach (55% in Koos grades I and II, 51.8% in Koos grades III and IV), with regression precluded by complete separation. Postoperative edema (30.4% vs 0.8%, p < 0.001) and gliosis (5.4% vs 0%, p = 0.029) were more frequent with the RS approach compared with the TL approach and remained significant after propensity score matching. In the RS group, greater TV was associated with radiological abnormalities, worse functional status, and rehabilitation discharge (p ≤ 0.026). In the TL group, higher TV was associated with longer operative time and hospital stay (both p < 0.001). Sinus thrombosis and other major complications did not differ significantly.</p><p><strong>Conclusions: </strong>TV and Koos grade are complementary predictors of VS outcomes. The TL approach achieves higher resection rates and earlier recovery in large tumors, whereas the RS approach preserves hearing but is linked to greater radiological morbidity. These findings support volume- and anatomy-guided surgical planning.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1128-1140"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648615","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":"Predicting postoperative hospice enrollment following stereotactic brain biopsy: a retrospective study and risk score development.","authors":"Arushi Tripathy, Edward S Harake, Ammar Ahmad, Nora Sharba, Anran Li, Sara Saleh, Oren Sagher, Jason A Heth, David Altshuler, Todd C Hollon, B Gregory Thompson, Aditya S Pandey, Yoshie Umemura, Wajd N Al-Holou","doi":"10.3171/2026.2.JNS251994","DOIUrl":"10.3171/2026.2.JNS251994","url":null,"abstract":"<p><strong>Objective: </strong>Stereotactic brain biopsy (SBB) is a key diagnostic tool in neuro-oncology. Due to the poor prognosis for many tumors, a significant subset of patients transition to hospice care shortly after the procedure. Current tools inadequately predict which patients are less likely to benefit from SBB. This study aimed to define preoperative factors that limit enrollment in adjuvant treatment in SBB candidates by characterizing patients who enrolled in hospice soon after the procedure. Understanding the safety profile and diagnostic utility of SBB in the context of hospice enrollment is essential for making informed decisions.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 616 patients who underwent SBB between 2000 and 2022 at a tertiary academic center with additional cost-of-care data up to 2025. Clinical, surgical, and pathological data were analyzed. The primary outcome was hospice enrollment within 1 month postoperatively. Multivariable Firth logistic regression identified key predictors, which were used to develop and validate probabilistic pre- and postoperative risk scores. A secondary cost analysis compared financial burdens between hospice and nonhospice patients.</p><p><strong>Results: </strong>One-month hospice enrollment occurred in 12.7% of patients. Independent predictors of hospice enrollment included age ≥ 60 years, basal ganglia biopsy, mental status deficits, Karnofsky Performance Status (KPS) score ≤ 50, prolonged intensive care unit stay, and grade 4 glioma. The comprehensive risk score achieved an optimism-corrected area under the receiver operating characteristic curve (AUC) of 0.81 at train time (0.85 test), with high-risk test-set patients having an 88.9% probability of 1-month hospice enrollment. The preoperative-only risk score attained a train time AUC of 0.78 (0.82 test). Patients progressing to hospice incurred significantly higher in-hospital care costs ($54,499 vs $35,967). Preoperative functional impairment (as measured by the KPS score) was also associated with higher 1-year hospice enrollment and 1-year mortality rates.</p><p><strong>Conclusions: </strong>This study presents a validated risk model predicting early hospice enrollment after SBB. Incorporating this tool into preoperative assessment may support clinicians in informed counseling, reduce unnecessary procedures or treatment, enhance shared decision-making, and mitigate financial burden, ultimately promoting patient-centered neuro-oncological care.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1161-1173"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648591","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":"MRI predictive value for adenoma detection in Cushing's disease and reader dependence: a multi-observer study.","authors":"Paul Eugène Constanthin, Amandine Ferrière, Francisco Sanchez-Gallardo, Marie-Laure Nunes, Jérôme Berge, Julien Engelhardt","doi":"10.3171/2026.2.JNS252331","DOIUrl":"10.3171/2026.2.JNS252331","url":null,"abstract":"<p><strong>Objective: </strong>MRI detection of pituitary microadenomas in Cushing's disease is inconsistent, and its impact on surgical outcomes remains debated. Diagnostic performance may vary by reader expertise and interpretation strategy. The authors sought to assess interrater agreement and compare diagnostic accuracy across expert MRI interpretation conditions.</p><p><strong>Methods: </strong>In this retrospective study at a tertiary referral center, preoperative pituitary MRI from 90 patients with biochemically confirmed Cushing's disease who underwent surgery (2012-2022) were independently interpreted by a trained pituitary neuroradiologist and two experienced pituitary neurosurgeons. Interrater agreement (Cohen's κ) and diagnostic performance were evaluated across 5 reading conditions: each reader individually and majority and unanimous voting among the 3 readers. The reference standard was adenoma identification at surgery. The authors calculated sensitivity/specificity-derived metrics, including balanced accuracy, area under the receiver operating characteristic curve (AUC-ROC), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). Three-month remission rates were compared between MRI-positive and MRI-negative interpretations within each reading condition using odds ratios (ORs) with 95% confidence intervals.</p><p><strong>Results: </strong>Interrater agreement was fair to moderate (κ = 0.34-0.44). Performance differed across reading conditions (global comparison, p < 0.001). The highest diagnostic performance was observed for one neurosurgeon and for unanimous voting (balanced accuracy 0.84 and 0.85; AUC-ROC 0.90 and 0.85, respectively). In these two conditions, an MRI-positive interpretation was associated with improved adenoma identification at surgery and greater 3-month remission compared with MRI-negative interpretations (PLR 4.38 and 15.35; NLR 0.16 and 0.32; OR for remission 12.38 and 10.07, respectively).</p><p><strong>Conclusions: </strong>In a surgically selected cohort with confirmed Cushing's disease, MRI localization of corticotroph microadenomas is strongly reader dependent. Consensus interpretation improves performance, and negative MRI are associated with lower remission rates, supporting optimization of preoperative imaging.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1048-1056"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648622","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":"Development and evaluation of a virtual dissection environment for anatomical learning in the endoscopic endonasal approach.","authors":"Tatsuya Uchida, Yuanzhi Xu, Taichi Kin, Vera Vigo, Yuhei Sangatsuda, Erik Burgos-Sosa, Masaki Ikegami, Aaron A Cohen-Gadol, Nobuhito Saito, Juan Carlos Fernandez-Miranda","doi":"10.3171/2026.2.JNS252684","DOIUrl":"10.3171/2026.2.JNS252684","url":null,"abstract":"<p><strong>Objective: </strong>A clear 3D understanding of complex skull base structures, including the cavernous sinus (CS), is vital for the endoscopic endonasal approach. However, traditional learning (TL) methods using textbooks and static materials have limits in fostering spatial comprehension. This study developed an interactive virtual dissection (VD) environment based on a virtual endoscopic skull base anatomy 3D computer graphics (VESA-3DCG) model to enhance 3D understanding of the sellar and parasellar regions and evaluated its educational effectiveness against TL methods.</p><p><strong>Methods: </strong>The VESA-3DCG model was constructed by modifying previously developed high-fidelity 3DCG models, which were designed with reference to the authors' previous anatomical studies of the sellar and parasellar regions, and integrated into a VD environment. Twenty-eight Japanese neurosurgical residents (postgraduate years 3-7) were randomly assigned to the VD or TL group. Both learning sessions were conducted remotely via a screen-sharing platform, allowing participants to view and interact with the presented materials in real time. A knowledge test covering four domains-bony landmarks, CS anatomy, microvascular anatomy, and neural anatomy-was administered before and after learning. Gain scores, defined as pre- to posttest improvement, were calculated per domain and overall. Group comparisons were performed to assess learning outcomes, and satisfaction and confidence were rated on a 5-point Likert scale.</p><p><strong>Results: </strong>The final model, consisting of 304 components and about 18.6 million polygons, accurately depicted the microanatomy of the sellar and parasellar regions. The VD environment supported interactive manipulation, including transparency and translucency control, rotation, zooming, virtual drilling, and retraction. Gain score analysis showed that the VD group achieved greater overall improvement in anatomical learning relative to the TL group (p = 0.036), with the most robust difference observed in the CS anatomy domain (p = 0.001). Within-group analysis in the VD group confirmed notable posttest gains in bony landmarks, CS anatomy, and neural anatomy. Participants reported high satisfaction and confidence with the VD environment.</p><p><strong>Conclusions: </strong>The VD environment based on the VESA-3DCG model offered an effective, interactive platform for anatomical learning. It demonstrated favorable educational effects, particularly for anatomically complex regions such as the CS, and showed feasibility as a complementary tool to TL, including in remote education settings.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1069-1080"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648570","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":"Reassessing the risk of hemorrhage progression in mild traumatic brain injury: the role of anticoagulant and antiplatelet therapy.","authors":"Tessa A Harland, Gregory Topp, Tarun Prabhala, Sruti Bandlamuri, Rachel Thiets, Fernando Figueroa, Samuel Ortiz, Matthew A Adamo, John Dalfino, Alexandra R Paul, John German, Junichi Yamamoto, Darryl DiRisio, Alan Boulos, Pouya Entezami","doi":"10.3171/2026.2.JNS252985","DOIUrl":"10.3171/2026.2.JNS252985","url":null,"abstract":"<p><strong>Objective: </strong>In patients with mild traumatic brain injury (TBI; Glasgow Coma Scale scores 13-15), the presence of anticoagulant or antiplatelet therapy, collectively referred to as blood thinners (BTs), has been presumed to elevate the risk of intracranial hemorrhage (ICH) progression. Current Brain Injury Guidelines (BIG) automatically classify all patients receiving BTs as high-risk (modified BIG [mBIG] 3), requiring hospital admission and repeat imaging. The aim of this study was to evaluate whether BTs independently increase the risk of hemorrhage progression, surgical intervention, or mortality in mild TBI with ICH, and whether risk varies by specific BT agent.</p><p><strong>Methods: </strong>The authors conducted a retrospective cohort study of 2312 adult patients presenting with mild TBI and traumatic ICH at a level 1 trauma center (2016-2021). Patients were categorized by mBIG criteria and then reclassified using hemorrhage characteristics (reclassified mBIG [RmBIG]), excluding BT status. Outcomes included radiographic progression, surgical intervention, and in-hospital mortality. A subgroup analysis was performed to assess outcomes by specific BT type.</p><p><strong>Results: </strong>Radiographic progression occurred in 14.1% of mBIG 3 patients versus 1.7% and 6.8% of mBIG 1 and 2 patients, respectively. Among reclassified patients, those receiving BTs had similar progression rates to non-BT patients within the same RmBIG category. Patients classified as mBIG 3 based only on BT use had significantly lower progression rates (11.9%) compared with those classified based on hemorrhage severity (18.1%, p < 0.001). Mortality and surgical intervention rates did not differ overall by BT status. In the BT subgroup analysis, warfarin was the only agent significantly associated with increased radiographic progression (OR 1.93, p = 0.01).</p><p><strong>Conclusions: </strong>Anticoagulant and antiplatelet therapy might not warrant automatic classification of all patients with mild TBI as high risk. While warfarin represents the upper end of the risk spectrum, most agents did not increase adverse outcomes. Refining BIG to incorporate hemorrhage features and agent-specific risk might improve patient care and resource utilization.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1081-1088"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648562","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":"Diagnostic utility of bilateral stereoelectroencephalography sampling in temporal lobe epilepsy.","authors":"Martin A Merenzon, Kurt R Lehner, Jonathan Ho, Shovan Bhatia, Joon Y Kang, Khalil S Husari, Nathan E Crone, Shenandoah Robinson, William S Anderson","doi":"10.3171/2026.2.JNS252667","DOIUrl":"https://doi.org/10.3171/2026.2.JNS252667","url":null,"abstract":"<p><strong>Objective: </strong>Temporal lobe epilepsy (TLE) is the most common form of medically refractory epilepsy in adults. While patients with concordant noninvasive findings and hippocampal sclerosis (HS) might proceed directly to surgery, those with discordant data, suspected bilateral involvement, or atypical presentation often require stereoelectroencephalography (SEEG). The diagnostic and therapeutic implications of bilateral temporal sampling remain uncertain. The aim of this study was to evaluate the yield and clinical impact of bilateral SEEG in TLE.</p><p><strong>Methods: </strong>The authors retrospectively reviewed data collected from patients with medically refractory epilepsy who underwent bilateral SEEG at a single institution from March 2017 and June 2025. Inclusion criteria were a pre-SEEG hypothesis of temporal onset, nonlesional or mesial TLE, with or without HS, and bilateral hippocampal/amygdala sampling. Patients were grouped as concordant, discordant, or bilateral based on pre-SEEG noninvasive data. The diagnostic yield, number of SEEG studies required to alter 1 patient's initial hypothesis, and seizure outcomes were analyzed.</p><p><strong>Results: </strong>Of 197 patients who underwent SEEG, 54 met inclusion criteria. Pre-SEEG hypotheses were concordant in 20 patients, discordant in 8 patients, and bilateral in 26 patients. SEEG revealed contralateral or bilateral seizure onset in 35% of concordant cases and confirmed unilateral onset in 46% of presumed bilateral cases. Overall, 21% of presumed unilateral TLE showed bilateral involvement. The number needed to treat was 2.9 for the concordant group and 2.2 for the bilateral group. Following SEEG, 38 patients underwent resection, laser ablation, or neuromodulation. At the last follow-up, 49% of patients achieved Engel class I or II outcomes, with best results for those with resection/ablation (79% Engel class I or II).</p><p><strong>Conclusions: </strong>Bilateral SEEG provides clinically meaningful information in both unilateral and bilateral TLE, uncovering contralateral involvement in presumed unilateral cases and confirming unilateral foci in nearly half of presumed bilateral cases. Although SEEG is not necessary for all patients with TLE-HS and concordant studies, when it is indicated, bilateral sampling might be important to avoid misclassification and guide resective/ablative versus neuromodulatory treatment planning.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648580","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 comprehensive analysis of ganglioneuromas: a 30-year experience of 101 patients.","authors":"Pavlos Texakalidis, Rahul Gogoi, Robert J Spinner","doi":"10.3171/2026.2.JNS252992","DOIUrl":"10.3171/2026.2.JNS252992","url":null,"abstract":"<p><strong>Objective: </strong>Ganglioneuromas (GNs) are rare benign tumors arising from sympathetic neural crest derivatives, with limited large-scale data guiding management. The objective of this study was to characterize the clinical presentation, imaging features, surgical management, and long-term outcomes of patients with GN treated at a single institution over a 30-year period.</p><p><strong>Methods: </strong>The authors conducted a retrospective review of all patients diagnosed with GN between 1995 and 2025 at a single institution. Clinical data, imaging characteristics, operative details, perioperative complications, and long-term outcomes were abstracted.</p><p><strong>Results: </strong>A total of 101 patients (62.3% female, mean age 26.9 ± 15.9 years) were identified. Tumors most commonly arose in the retroperitoneum (n = 46, 45.5%), thoracic paraspinal/mediastinal region (n = 33, 32.7%), presacral space (n = 18, 17.8%), and cervical region (n = 4, 4%). The mean tumor dimensions on MRI were 8.5 ± 3.8 × 6.6 ± 3.2 × 5.8 ± 3.7 cm. Most lesions (72%) were incidental findings. Seventy patients underwent 72 surgeries, of which 69.4% had preoperative biopsy confirmation. Gross-total resection (GTR) was achieved in 73.6% of cases (53/72) and subtotal resection (STR) was performed in 26.4% (19/72). Short-term postoperative complications occurred in 43.1% of cases, most commonly neurological deficits (22.2%). The mean hospital length of stay was 4.6 ± 3.7 days. At the final follow-up (mean duration 33.8 ± 42.6 months), 46.5% of patients were stable, 42.3% had improved, and 11.3% had worsened from baseline. Two patients experienced recurrence (2.9%, 2/70). No malignant transformations were observed. Thirty-one patients were managed with observation (mean age 32.3 ± 17.7 years; mean follow-up duration 90.9 ± 151 months). Observation was chosen primarily due to proximity to major vascular or neural structures (74.2%). No patient in the observation group developed new symptoms, and 2 tumors exhibited minimal interval growth (0.08-0.17 cm/year).</p><p><strong>Conclusions: </strong>GNs demonstrate indolent behavior, low recurrence rates, and no observed malignant transformation in this large cohort. GTR is achievable in most cases, but STR provides excellent long-term control when required to avoid morbidity. Observation is safe for asymptomatic tumors, particularly when adjacent to critical structures, with no growth observed on long-term follow-up, except for minimal growth in few cases. These findings support an individualized, risk-based approach to management.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1223-1229"},"PeriodicalIF":3.8,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648567","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}