Journal of neurosurgery最新文献

{"title":"Predicting the natural history of unruptured brain arteriovenous malformations: external validation of rupture risk scores.","authors":"Juan E Basilio-Flores, Joel A Aguilar-Melgar, Henry Pacheco-Fernandez Baca","doi":"10.3171/2024.12.JNS241316","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241316","url":null,"abstract":"<p><strong>Objective: </strong>The current management of brain arteriovenous malformations (bAVMs) is controversial. A group of patients will undergo conservative management assuming a higher risk from intervention than from natural history of the disease. However, patients with increased risk of future bleeding could benefit from intervention. Therefore, accurate prediction of rupture risk is needed. This study was aimed at identifying published rupture risk scoring systems and externally validating their performance in a single-center population.</p><p><strong>Methods: </strong>This retrospective observational study included patients with bAVM who presented to the authors' institution during the period from January 2010 to December 2020. A literature search was performed to identify published rupture risk scales. Data relevant for scoring were extracted from the study population. Discrimination, classification, and calibration analyses were performed for all selected scales with ruptured presentation as outcome.</p><p><strong>Results: </strong>A total of 269 bAVMs (in 258 patients) were included. Significant differences between ruptured and unruptured cases were observed for several variables including location, size, flow-related-associated aneurysms, single arterial feeder, and venous tortuosity. The following 4 scoring systems were selected: Nataf; race, exclusive deep location, AVM size < 3 cm, venous drainage exclusively deep and monoarterial feeding (R2eD AVM); AVM rupture index (ARI); and ventricular system involvement, venous aneurysm, deep location, and exclusively deep drainage (VALE). The performance of the Nataf and ARI scales was nondiscriminatory and that for R2eD AVM and VALE scales was poor. A logistic regression model was obtained from the component variables of selected scales and included the following variables: size, location, venous tortuosity, and ventricular involvement. Its performance was just fair.</p><p><strong>Conclusions: </strong>Currently available rupture risk scoring systems showed nondiscriminatory to poor performance. Based on its observed performance, the R2eD AVM system could be preferentially used. Further research on rupture risk factors for derivation of better scales is needed.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997057","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":"AtlasGPT: a language model grounded in neurosurgery with domain-specific data and document retrieval.","authors":"Rohaid Ali, Hael F Abdulrazeq, Advait Patil, Morgan Cheatham, Ian D Connolly, Oliver Y Tang, Cody A Doberstein, Tori Riccelli, Kevin T Huang, Ganesh M Shankar, Theresa Williamson, John H Shin, Bob Carter, Radmehr Torabi, Christine K Lee, Deus Cielo, Albert E Telfeian, Ziya L Gokaslan, Aaron A Cohen-Gadol, James Zou, Wael F Asaad","doi":"10.3171/2024.12.JNS241607","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241607","url":null,"abstract":"<p><strong>Objective: </strong>Large language models (LLMs) have shown promising performance on medical licensing examinations, but their ability to excel in subspecialty domains and their robustness under adversarial conditions remain unclear. Herein, the authors present AtlasGPT, a subspecialty-focused LLM for neurosurgery, and evaluate its performance on a benchmark multiple-choice question bank and under adversarial testing, as well as its ability to generate high-quality explanations.</p><p><strong>Methods: </strong>AtlasGPT was built by fine-tuning GPT-4 architecture and retrieval-augmented generation from neurosurgical knowledge sources. Its performance was compared with that of GPT-4 and Gemini Advanced on a 149-question neurosurgery examination. Adversarial testing assessed robustness to misinformation. Answer explanations were rated by 15 independent neurosurgeons and compared with the question bank.</p><p><strong>Results: </strong>Across all 149 questions and on text-only questions, AtlasGPT (96%) outperformed Gemini Advanced (93%) and GPT-4 (88%) in accuracy. In adversarial testing, under which AtlasGPT was tasked with identifying medical misinformation, it was fooled 14% of the time, compared with 44% for GPT-4 and 68% for Gemini Advanced. Neurosurgeons rated AtlasGPT's answer explanations as significantly more comprehensive, relevant, and better referenced than the question bank's explanations of the responses (p < 0.001). AtlasGPT did not demonstrate any evidence of hallucination or other content that would be harmful for patient care or the surgeon's clinical decision.</p><p><strong>Conclusions: </strong>AtlasGPT demonstrates the potential of subspecialty-focused LLMs to outperform general models, exhibit robustness to misinformation, and generate high-quality explanations. Domain-specific LLMs may improve medical knowledge, decision-making, and educational materials in complex fields like neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004534","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 series of 309 awake surgeries with transcortical approach for IDH-mutant low-grade glioma involving the insula: long-term onco-functional outcomes in 253 consecutive patients.","authors":"Hugues Duffau","doi":"10.3171/2025.1.JNS242462","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242462","url":null,"abstract":"<p><strong>Objective: </strong>In low-grade glioma (LGG), awake surgery (AS) with intraoperative functional mapping minimizes morbidity while increasing the extent of resection (EOR). However, the actual role of AS for insular LGG resection through the opercula is still debated. The aim of this study was to investigate the long-term results after AS via a transcortical approach in patients with LGG within the insula, and to compare outcomes between pure insular gliomas and gliomas also invading other lobes.</p><p><strong>Methods: </strong>Patients who underwent AS with functional-based resection via the opercula performed by the author for an isocitrate dehydrogenase-mutant grade 2 glioma involving the insula were selected (June 2002-January 2024). Functional and oncological outcomes were analyzed by comparing pure insular gliomas (group 1) versus insular-centered gliomas also involving the frontal and/or temporal and/or parietal lobes (group 2).</p><p><strong>Results: </strong>In this consecutive cohort, 309 ASs were achieved in 253 patients (132 men [52.2%], mean age 37.5 ± 9.5 years). Among 214 patients (84.5%) with epilepsy before surgery, 55 had intractable seizures (21.7%). The preoperative mean Karnofsky Performance Scale score was 93.1 ± 7.4, with 206 patients (81.4%) working before surgery. The series included 147 left-sided gliomas (58.1%), with a mean preoperative tumor volume for both sides of 70.1 ± 50.1 cm3 with 39 total tumors (15.4%) in group 1 and 214 total tumors (84.6%) in group 2. No patients except 2 (99.2%) had a permanent postoperative deficit (mean Karnofsky Performance Scale score 93 ± 6.6), with 199 patients returning to work (96.6%). Only 20 patients (7.9%) continued to suffer from intractable epilepsy. The mean EOR was 89.4% ± 8.4% (mean residual tumor volume: 9.6 ± 13.1 cm3). There were 166 astrocytomas (65.6%) and 87 oligodendrogliomas (34.4%). Fifty-three patients (20.9%) received immediate postoperative adjuvant therapy and 49 patients (19.3%) underwent subsequent AS. The mean follow-up was 7.1 ± 3.9 years, with an overall survival rate of 80.2% (203 patients were still alive at last evaluation). More patients had an incidental glioma in group 1 (p = 0.00009), whereas there was a higher rate of intractable seizures (p = 0.0019) and a greater tumor volume before surgery in group 2 (p < 0.00001). Nonetheless, the EOR and the rate of postoperative intractable seizures were similar in both groups, with more patients in group 2 resuming work (p = 0.001).</p><p><strong>Conclusions: </strong>This is the largest homogeneous surgical experience of LGGs involving the insula that were resected through the opercula based on awake mapping. The results show a high percentage of functional preservation and return to work, with a high overall survival rate.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009172","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":"Blood biomarkers for brain injury in chronic subdural hematomas: postoperative dynamics and relation to long-term outcome.","authors":"Teodor Svedung Wettervik, Caroline Lindblad, Felix Axelsson, Christine Chidiac, Fernando Gonzalez-Ortiz, Kaj Blennow, Henrik Zetterberg, Jimmy Sundblom","doi":"10.3171/2025.1.JNS242942","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242942","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate whether the biomarkers neuron-specific enolase (NSE), glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), and tau (total [t] and brain-derived [BD]) are elevated in plasma preoperatively; if there is a dynamic biomarker response to surgery; and if the biomarker levels are related to long-term outcome in chronic subdural hematomas (CSDHs).</p><p><strong>Methods: </strong>Eighty-five CSDH patients surgically treated between 2022 and 2023 at Uppsala University Hospital, Uppsala, Sweden, were included in this prospective, observational study. NSE, GFAP, NfL, t-tau, and BD-tau were evaluated in plasma pre- and postoperatively (6-24 hours after surgery) and in the CSDH fluid. Health-related quality of life was evaluated using the 5-level EQ-5D (EQ-5D-5L) at 6 months postoperatively.</p><p><strong>Results: </strong>GFAP, NfL, and tau levels decreased after CSDH surgery (p < 0.02). NSE and BD-tau levels also decreased, but not significantly. Older age and larger CSDH volume were associated with higher preoperative GFAP, NfL, and BD-tau levels (p < 0.05). Higher preoperative values and greater dynamics (Δ [postoperative value - preoperative value]) of GFAP, NfL, and BD-tau correlated significantly with worse levels of several EQ-5D-5L domains (p < 0.05). A higher preoperative NfL level in plasma was independently associated with a lower EQ-5D-5L visual analog scale score (p < 0.001).</p><p><strong>Conclusions: </strong>Surgical CSDH patients exhibit ongoing central nervous system cellular injury, demonstrated via increased fluid biomarkers for brain injury preoperatively, which immediately improved after surgery and was strongly related to long-term outcome. The extent of preoperative biomarker elevation could aid in the decision-making for surgical indication and urgency.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968037","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":"High-grade glioma: combined use of 5-aminolevulinic acid and intraoperative ultrasound for resection and a predictor algorithm for detection.","authors":"Juan Ángel Aibar-Durán, Rosa M Mirapeix, Alberto Gallardo Alcañiz, Laura Salgado-López, Berta Freixer-Palau, Vicente Casitas Hernando, Fernando Muñoz Hernández, Cristian de Quintana-Schmidt","doi":"10.3171/2024.12.JNS242496","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242496","url":null,"abstract":"<p><strong>Objective: </strong>The primary goal in neuro-oncology is the maximally safe resection of high-grade glioma (HGG). A more extensive resection improves both overall and disease-free survival, while a complication-free surgery enables better tolerance to adjuvant therapies such as chemotherapy and radiotherapy. Techniques such as 5-aminolevulinic acid (5-ALA) fluorescence and intraoperative ultrasound (ioUS) are valuable for safe resection and cost-effective. However, the benefits of combining these techniques remain undocumented. The aim of this study was to investigate outcomes when combining 5-ALA and ioUS.</p><p><strong>Methods: </strong>From January 2019 to January 2024, 72 patients (mean age 62.2 years, 62.5% male) underwent HGG resection at a single hospital. Tumor histology included glioblastoma (90.3%), grade IV astrocytoma (4.1%), grade III astrocytoma (2.8%), and grade III oligodendroglioma (2.8%). Tumor resection was performed under natural light, followed by using 5-ALA and ioUS to detect residual tumor. Biopsies from the surgical bed were analyzed for tumor presence and categorized based on 5-ALA and ioUS results. Results of 5-ALA and ioUS were classified into positive, weak/doubtful, or negative. Histological findings of the biopsies were categorized into solid tumor, infiltration, or no tumor. Sensitivity, specificity, and predictive values for both techniques, separately and combined, were calculated. A machine learning algorithm (HGGPredictor) was developed to predict tumor presence in biopsies.</p><p><strong>Results: </strong>The overall sensitivities of 5-ALA and ioUS were 84.9% and 76%, with specificities of 57.8% and 84.5%, respectively. The combination of both methods in a positive/positive scenario yielded the highest performance, achieving a sensitivity of 91% and specificity of 86%. The positive/doubtful combination followed, with sensitivity of 67.9% and specificity of 95.2%. Area under the curve analysis indicated superior performance when both techniques were combined, in comparison to each method used individually. Additionally, the HGGPredictor tool effectively estimated the quantity of tumor cells in surgical margins.</p><p><strong>Conclusions: </strong>Combining 5-ALA and ioUS enhanced diagnostic accuracy for HGG resection, suggesting a new surgical standard. An intraoperative predictive algorithm could further automate decision-making.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007211","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":"Exploring local and network effects of subthalamic stimulation on semantic verbal fluency in Parkinson's disease.","authors":"Guangrui Zhao, Yifeng Cheng, Guangfeng Li, Lanxin Li, Guangyan Cong, Qiyuan Zhao, Feng Li, Yuzhang Wu, Chuan Du, Jingtao Yan, Min Wang, Keke Feng, Shaoya Yin","doi":"10.3171/2024.12.JNS241574","DOIUrl":"https://doi.org/10.3171/2024.12.JNS241574","url":null,"abstract":"<p><strong>Objective: </strong>A decline in verbal fluency (VF) after subthalamic stimulation has been frequently reported; however, the reasons and mechanisms for this decline remain unclear. This study investigated the impact of subthalamic stimulation on semantic VF decline, analyzed the associated factors, and uncovered the relevant mechanisms by exploring local and network effects.</p><p><strong>Methods: </strong>Included in the study were 78 patients with Parkinson's disease who were categorized into either the stable group (n = 32) or the decliner group (n = 46) based on whether semantic VF decreased after subthalamic stimulation. The baseline and follow-up clinical profiles were compared between the two groups. Local and network effect models were constructed based on volume of tissue activation (VTA).</p><p><strong>Results: </strong>Semantic VF decline was closely related to the Hoehn and Yahr stage (OR 3.38, p = 0.024), left standardized X-coordinate (OR 1.928, p = 0.025), and left standardized Y-coordinate (OR 0.534, p = 0.013). The VTA-covered motor subthalamic nucleus was negatively correlated with semantic VF. The probabilistic stimulation maps indicated that the stimulation site for semantic VF decline was closer to the optimal site for motor symptom improvement. Finally, fiber filtering and structural network analyses indicated that the decline in semantic VF was associated with a decrease in prefrontal cortex connectivity induced by stimulation, including the dorsolateral prefrontal cortex.</p><p><strong>Conclusions: </strong>Subthalamic stimulation resulted in a decline in semantic VF. The semantic VF decline is related not only to the severity of postoperative disease but also to the effects of stimulation, and this effect is lateralized, especially in the left hemisphere.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012325","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. Impact of early mobilization on the recovery of focal motor weakness following cSDH evacuation.","authors":"Rodrigo Batata, Vasco Sá Pinto, Sérgio Sousa, Eduardo Cunha, Alfredo Calheiros","doi":"10.3171/2025.1.JNS243240","DOIUrl":"https://doi.org/10.3171/2025.1.JNS243240","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022797","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":"Determining factors predictive of ventriculoperitoneal shunt failure in a cohort of adults.","authors":"Mohammed Nadeem, Keyur Shah, Abhijit Goyal-Honavar, Vishal Jirankali, Gaurav Tyagi, Alok Mohan Uppar, Manish Beniwal, Subhas Kanti Konar, Gyani Jail Singh, Lingaraju S Thyagaturu, Dhaval Shukla, Dwarakanath Srinivas","doi":"10.3171/2024.12.JNS242338","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242338","url":null,"abstract":"<p><strong>Objective: </strong>Despite being one of the most frequently performed neurosurgical procedures, there is lack of consensus on the factors that predict failure after ventriculoperitoneal (VP) shunt placement. The aim of this study was to contribute data from a large single-center cohort and discuss measures to address the variables identified, adding to the literature on this subject.</p><p><strong>Methods: </strong>All patients ≥ 18 years of age who underwent initial VP shunt placement from January 2015 to April 2021 at our center were included. Demographic and preoperative data, as well as details of the surgery, were collected. The occurrence of failure, including the time to failure and the causes and sites of failure, were assessed.</p><p><strong>Results: </strong>This study included 1425 patients (mean age 41.8 ± 15.1 years; 793 male, 632 female). Over a mean follow-up of 42 months, failure occurred in 120 patients (8.4%) at a mean time to revision of 2.9 months. Multivariate analysis identified a left-sided location (HR 4.602, 95% CI 2.893-7.320, p < 0.001), a single operating surgeon (HR 2.793, 95% CI 1.904-3.984, p < 0.001), placement at night (HR 2.994, 95% CI 2.136-4.184, p < 0.001), and entry at Kocher's point (HR 1.949, 95% CI 1.068-3.558, p = 0.029) as predictive of shunt failure, while posthemorrhagic and postmeningitic hydrocephalus remained significantly associated with early shunt failure (HR 3.058, 95% CI 1.308-7.142, p = 0.010), as did CSF protein levels > 100 mg/dL (HR 2.849, 95% CI 1.103-7.352, p = 0.03).</p><p><strong>Conclusions: </strong>Failure of VP shunts occured in 8.4% of adult patients. A left-sided shunt, a single operating surgeon, shunts placed at night, and entry at Kocher's point were significantly associated with shunt failure. Although not associated with overall shunt failure, posthemorrhagic and postmeningitic hydrocephalus and CSF protein levels > 100 mg/dL were significantly associated with early shunt failure.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970399","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":"Fatigue, anxiety, and cognitive effects in neurosurgical patients: a prospective multicenter longitudinal study.","authors":"Anne Jian, Anthea O'Neill, Jason Dong, Calvin Hendoro, Leon Lai, Katharine Drummond","doi":"10.3171/2025.1.JNS241195","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241195","url":null,"abstract":"<p><strong>Objective: </strong>Existing studies on postoperative fatigue (POF) following neurosurgery are generally small, retrospective, and lack longitudinal data. Despite frequent associations with temporary cognitive impairment and mood disorders, the precise relationship remains unclear. This study investigated POF following neurosurgery and its association with anxiety, depression, and cognitive impairment.</p><p><strong>Methods: </strong>This prospective multicenter study enrolled patients undergoing elective or semi-elective cranial or spinal surgery at four centers. Assessments including the Fatigue Severity Scale (FSS), Christensen Fatigue Scale, visual analog scale for pain, Cognitive Failures Questionnaire (CFQ), and Hospital Anxiety and Depression Scale (HADS) were conducted preoperatively and 1 week, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Changes in scores over time were analyzed using random-effects models, while the relationship between FSS score and anxiety, depression, and CFQ scores was analyzed using linear regression. Baseline characteristics including antiepileptic drug use, Charlson Comorbidity Index, and complications were collected.</p><p><strong>Results: </strong>From 2017 to 2022, 247 patients were recruited, with 182 (92 cranial, 90 spinal) patients included in the final analysis. Overall, 59% of cranial surgery patients experienced fatigue at baseline, with an average increase in FSS score of 0.46 (95% CI -0.12 to 0.72, p = 0.01) at 1 week compared with preoperatively. The FSS score reverted to baseline at 6 weeks. Of spinal surgery patients, 68% reported fatigue at baseline. They had no significant increase in FSS score postoperatively but demonstrated improvement by 6 weeks, which was sustained up to 12 months. Preoperative fatigue and depression predicted increased POF. Cranial surgery patients had worse depression at 1 week postoperatively before returning to baseline at 6 weeks. Depression in spinal surgery patients did not worsen postoperatively but rather improved from 6 weeks to 12 months. Anxiety improved in both cohorts postoperatively. CFQ scores improved at 1 and 6 weeks and then returned to preoperative levels in both cohorts. Elevated HADS scores (≥ 8) correlated with a 6-point higher CFQ score. Postoperative pain significantly influenced POF, anxiety, and depression, with POF associated with anxiety, depression, and cognitive impairment.</p><p><strong>Conclusions: </strong>Cranial surgery patients experienced transiently heightened POF at 1 week, reverting to baseline, while spinal surgery patients had improved POF from 6 weeks onward. Preoperative fatigue and depression predicted worse POF, which in turn was associated with increased anxiety, depression, and cognitive dysfunction. Postoperative pain also had a major influence on these symptoms.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971935","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":"Tear production after vestibular schwannoma surgery and intermediate nerve function.","authors":"Wieneke M A van Vollenhoven, Erik F Hensen, Nick P de Boer, Radboud W Koot, Jeroen C Jansen, Martijn J A Malessy","doi":"10.3171/2024.12.JNS242236","DOIUrl":"https://doi.org/10.3171/2024.12.JNS242236","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the function of the intermediate nerve, the authors objectively quantified tear production before and after vestibular schwannoma (VS) surgery.</p><p><strong>Methods: </strong>This prospective cohort study comprised 111 patients who underwent resection of unilateral VS. Tear production was objectively assessed in both eyes in millimeters using the Schirmer test. The difference between tear production of the eye on the nontumor side and that of the tumor side was assessed, before and after surgery. Sixty randomly selected patients had a second postoperative Schirmer test to assess change in tear production over time. The postoperative use of eye drops to treat dry eye was evaluated. Tear production was correlated with anterior-posterior tumor size, extent of resection, and facial nerve motor function (House-Brackmann grade) at the time of the Schirmer test with univariate linear regression.</p><p><strong>Results: </strong>The mean ± SD preoperative difference in tear production between the nontumor side and the tumor side eye was 0 ± 9.0 mm. This increased significantly to 8 ± 13.7 mm in the direct postoperative phase (p < 0.001) and remained nearly constant at a mean of 8.0 (SD 4.9) months after surgery, reaching 9 ± 12.2 mm. The postoperative difference in tear production between eyes was significantly correlated to preoperative tumor size (p = 0.039) but not to facial nerve motor function (p = 0.213) nor extent of surgery (p = 0.325). Postoperatively, eye lubricants were used by 74 (67%) patients. The tear production of the eye on the tumor side was significantly lower in patients using eye lubricants (6.6 ± 7.2 mm) compared to patients who did not (10.8 ± 12.2 mm) (p = 0.024).</p><p><strong>Conclusions: </strong>Tear production after VS resection was affected in the majority of patients. The resulting differences between eyes were not straightforward. The larger the tumor, the greater the postoperative difference in tear production between the eyes. Change in tear production is inherently linked to VS surgery and may require repeated use of eye lubricants, which is cumbersome; this is why patients should be informed about the potential for decreased tear production postoperatively.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063939","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}