Journal of neurosurgery最新文献

{"title":"Predicting gross-total resection in skull base chondrosarcoma: a multi-institutional machine learning study.","authors":"Juan Pablo Zuluaga-Garcia, Franco Rubino, Esteban Ramirez Ferrer, Georgios A Zenonos, Hanna Algattas, Paul Gardner, Juan Carlos Fernandez-Miranda, Vera Vigo, Daniel M Prevedello, Franco DeMonte, Shaan M Raza","doi":"10.3171/2026.2.JNS252854","DOIUrl":"10.3171/2026.2.JNS252854","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to develop and validate an anatomy-driven model that predicts gross-total resection (GTR) of skull base chondrosarcomas (SBCs).</p><p><strong>Methods: </strong>The authors conducted a retrospective multi-institutional analysis of consecutive SBCs resected at 4 academic centers in 2000-2024. Thirteen preoperative variables of interest included tumor location (petroclival, peri-lacerum, anterior, or lateral skull base), maximal tumor diameter, internal carotid artery (ICA) encasement, compartmental extension, cranial nerve (CN) involvement, prior radiotherapy and/or surgery, synchondrosis of origin, and planned operative approach. Data were split into 75% training (n = 139) and 25% validation (n = 46) sets. Five algorithms were tuned: generalized linear model (GLM), random forest, support vector machine, k-nearest neighbors, and eXtreme Gradient Boosting. For interpretability, a multivariable logistic regression model was fitted and a nomogram for predicting GTR was built. Discrimination performance was summarized by the area under the curve (AUC), accuracy, sensitivity, specificity, and Brier score.</p><p><strong>Results: </strong>A total of 185 consecutive SBCs were identified. Anatomical burden varied by location: cavernous sinus invasion clustered in peri-lacerum (64.5%) and petroclival (57.1%) SBCs, jugular foramen extension occurred largely in petroclival cases (38.1%), and sinonasal or orbital spread characterized anterior midline lesions. Surgical approaches mirrored this distribution, endonasal routes for peri-lacerum (80%) and petroclival (63.4%) tumors, whereas open approaches predominated for lateral tumors (84.6%). The overall GTR rate was 56%, with rates of 52.4%, 67.7%, 76.9%, and 66.7% for petroclival, peri-lacerum, lateral, and midline tumors, respectively (p = 0.186). For petroclival disease, the surgical choice was decisive (p < 0.001), with GTR rates of 72.1% for the endoscopic transpterygoid approach (ETPA), 25.7% for open surgery, and 41.7% for the midline endoscopic endonasal approach (EEA). Multivariable analysis demonstrated significantly decreased odds of GTR with graded ICA encasement (ORs 3.12 for 90°-180°, 7.41 for 181°-270°, 9.76 for 271°-359°, 8.52 for 360°, compared with no encasement), prior radiotherapy (OR 4.04), petroclival location (OR 4.72), lateral location (OR 3.29), infratemporal fossa extension (OR 2.75), and CN VII-VIII involvement (OR 2.82). The ETPA, as compared to open surgery, was independently associated with higher odds of GTR (i.e., decreased odds of subtotal resection; OR 0.22, p < 0.001), with a favorable trend for midline EEA (OR 0.37, p = 0.063). The GLM exhibited the best discrimination with an AUC of 0.838 and Brier score of 0.19 (accuracy 0.898).</p><p><strong>Conclusions: </strong>Anatomical factors, especially petroclival tumor origin, ICA encasement, and lower CN corridors, are the principal barriers to complete resection of SBCs. Th","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1105-1116"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584476","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":"Maternal and fetal treatment outcomes of pregnancy-related aneurysmal subarachnoid hemorrhage: a nationwide study.","authors":"Anni Pohjola, Aino Korhonen, Liisa Verho, Aleksanteri Asikainen, Karoliina Aarnio, Kirsi Rantanen, Mika Gissler, Hannele Laivuori, Petra Ijäs, Miikka Korja","doi":"10.3171/2026.2.JNS252575","DOIUrl":"10.3171/2026.2.JNS252575","url":null,"abstract":"<p><strong>Objective: </strong>There is a paucity of data concerning the outcomes of aneurysmal subarachnoid hemorrhage (aSAH) in pregnant women. In this study, the authors investigated the clinical progression, treatment, and outcomes in women and their unborn children after aSAH during pregnancy.</p><p><strong>Methods: </strong>This nationwide retrospective population-based cohort study in Finland spans the years 1987-2016. The authors identified pregnant women diagnosed with aSAH through the Care Register for Health Care and Medical Birth Register (1,773,728 deliveries) and sudden prehospital deaths caused by aSAH from the Cause of Death Register. The authors reviewed medical records to delineate the clinical trajectories of each woman with aSAH.</p><p><strong>Results: </strong>Twenty-eight pregnant women were hospitalized with aSAH between 1987 and 2016. In addition, 3 pregnant women died suddenly of aSAH at home or in the emergency department before hospitalization. Eight (29%) of the 28 hospitalized pregnant women were active smokers. The maximum mean aneurysm diameter was 7.1 (SD 4.2) mm. The aneurysm was surgically treated in 21 (75%) of the 28 women, endovascularly in 4 (14%), and by both methods in 3 (11%) patients. Most procedures (n = 23, 82%) were performed before childbirth. The most common method of delivery was emergency cesarean section (CS) (n = 13, 46%) followed by elective CS (n = 8, 29%). All infants of the hospitalized women survived. Vasospasm occurred in 5 (18%) and delayed cerebral ischemia in 3 (11%) women. There were no maternal or fetal deaths during hospitalization. The median modified Rankin Scale score at 3 months was 1 (IQR 0-2) for the hospitalized women. Two (7%) women received ventriculoperitoneal shunts for post-aSAH hydrocephalus.</p><p><strong>Conclusions: </strong>Aneurysmal SAH during pregnancy is associated with exceptionally low maternal and neonatal mortality. All maternal and fetal fatalities were due to sudden prehospital deaths. Pregnancy-related immunological modulation and its potential benefits on aSAH outcomes represent a compelling topic for future research.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"900-911"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584494","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":"Cortical wiring cost abnormalities in mesial temporal lobe epilepsy with hippocampal sclerosis: implications for postoperative seizure recurrence.","authors":"Fei Zhu, Bo Tao, Yue Li, Ziyang Gao, Yi Liang, Wei Yu, Yuan Xiao, Yu Zhao, Xiutian Sima, Bo Yan, Na Hu, Dong Zhou, Yingying Tang, Su Lui","doi":"10.3171/2026.2.JNS252297","DOIUrl":"https://doi.org/10.3171/2026.2.JNS252297","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative seizure recurrence in mesial temporal lobe epilepsy (mTLE) with hippocampal sclerosis (HS) has been linked to alterations in structural network organization. However, existing studies have primarily focused on white matter pathways, while gray matter wiring attributes remain largely unknown. This study aimed to investigate whether alterations in gray matter wiring costs are associated with postoperative seizure recurrence in mTLE with HS.</p><p><strong>Methods: </strong>Forty-seven patients with unilateral mTLE who underwent surgery and 48 matched healthy controls were enrolled in the study. All patients had pathologically confirmed HS and were classified as seizure-free (SF; n = 27) or non-seizure-free (NSF; n = 20) with ≥ 2 years of follow-up. Based on preoperative 3D T1-weighted MRI, surface-based geodesic metrics were computed as proxies of cortical wiring costs. Global and local wiring costs were compared across groups, and a support vector machine (SVM) classifier was used to determine their individual-level classification value for postoperative seizure outcomes.</p><p><strong>Results: </strong>Global wiring costs decreased in the ipsilateral temporal cortex in patients with mTLE-HS, with a more significant and widespread reduction in the NSF group. Local wiring costs showed diffuse intra- and interregional abnormalities within the sensorimotor and default mode networks in patient groups, with more pronounced disturbances in the NSF group. These wiring abnormalities were not affected by hippocampal subfield atrophy, epilepsy duration, or antiseizure medications, and could train SVM models to distinguish NSF patients from SF patients (area under the receiver operating characteristic curve = 0.86).</p><p><strong>Conclusions: </strong>Abnormalities of cortical wiring costs were observed in mTLE-HS, particularly in patients with postoperative seizure recurrence. These abnormalities may reflect increased long-range connectivity and short-range reorganization within gray matter, offering novel insights into the underlying pathophysiology of this illness and providing potential for outcome prediction.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584450","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. The utility of biopsy prior to craniotomy in high-grade glioma.","authors":"Andrew J Fabiano","doi":"10.3171/2026.2.JNS26270","DOIUrl":"10.3171/2026.2.JNS26270","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1261-1262"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584507","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":"Association between intraoperative parameters and pain reduction after radiofrequency rhizotomy in patients with trigeminal neuralgia.","authors":"Gokberk Erol, Alperen Sozer, Ozan Yavuz Tufek, Imran Asadov, Beste Gulsuna, Mesut Emre Yaman","doi":"10.3171/2026.2.JNS252880","DOIUrl":"10.3171/2026.2.JNS252880","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous radiofrequency (RF) rhizotomy is one of the most effective minimally invasive treatments for trigeminal neuralgia (TN) that is unresponsive to medication. Although it is commonly used, the impact of intraoperative parameters, especially CSF outflow, prelesion impedance, and total thermal dose, on long-term pain control remains unclear. This study aimed to evaluate the relationship between these procedural factors and postoperative pain reduction.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database was performed of patients who underwent percutaneous RF rhizotomy for TN at a single tertiary facility from February 2019 to December 2023. Recorded variables included demographic data, TN subtype, impedance of electrodes, temperature and duration of lesioning, CSF outflow, and sensory responses during lesioning. Thermal dose was measured by cumulative equivalent minutes at 43°C (CEM43) and temperature-by-time summation. Outcomes were assessed using the Barrow Neurological Institute (BNI) pain intensity scale immediately after treatment and during the final follow-up. Treatment success was defined as a BNI score of IIIa or lower. Logistic regression and correlation analyses were performed to identify predictors of treatment efficacy.</p><p><strong>Results: </strong>A total of 165 patients met the inclusion criteria, with a median follow-up duration of 19 months. CSF outflow occurred in 116 of 165 procedures (70.3%), showing a moderate positive correlation with both immediate (ρ = 0.418, p < 0.001) and long-term (ρ = 0.539, p < 0.001) reduction in pain. Univariate analysis indicated that CSF outflow was a significant predictor of treatment success (p < 0.001), while higher prelesion impedance, longer lesioning durations, and greater thermal dose were associated with lower odds of success. In multivariate models, CSF outflow and prelesion impedance were the most significant independent predictors of achieving a BNI score ≤ IIIa at the final follow-up. Temperature-by-time summation outperformed CEM43 in predicting outcomes, suggesting that prolonged lesioning reflects technical difficulty rather than therapeutic benefit.</p><p><strong>Conclusions: </strong>CSF outflow and low prelesion impedance were the most reliable intraoperative markers of effective percutaneous RF for TN, likely indicating accurate electrode placement within the trigeminal cistern and optimal electrical coupling. Conversely, longer lesion durations and increased cumulative thermal exposure did not improve outcomes, highlighting that accurate positioning, rather than aggressive lesioning, is key to achieving long-lasting pain relief. These results support incorporating CSF outflow and impedance into routine decision-making for RF rhizotomy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1208-1214"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584490","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":"Incidence and predictors of complications, readmission, and reoperation following endoscopic transsphenoidal surgery for pituitary adenomas.","authors":"John Pham, David J Cote, Keiko M Kang, David Gomez, Ishan Shah, Sindhu Daggupati, Kevin G Liu, Jonathan Sisti, Mark Shiroishi, Robert G Briggs, John Carmichael, Gabriel Zada","doi":"10.3171/2026.2.JNS252393","DOIUrl":"10.3171/2026.2.JNS252393","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic transsphenoidal surgery (eTSS) is a common neurosurgical procedure used to treat pituitary adenomas (PAs). The authors evaluated the incidence of complications, early readmission, and early reoperation following eTSS for PAs and identified clinical, surgical, and tumor characteristics predictive of these outcomes.</p><p><strong>Methods: </strong>The data of all patients with histologically confirmed PAs who underwent eTSS at the authors' institution between May 2011 and September 2024 were retrospectively reviewed. Thirty-day postoperative complications were grouped into surgical and medical categories. Early readmission and early reoperation were defined as occurring within 90 days of discharge and surgery, respectively.</p><p><strong>Results: </strong>A total of 709 endoscopic transsphenoidal operations (655 direct and 54 extended approaches) were performed in 693 patients. The median tumor diameter (IQR) was 24 (17-32) mm, and 656 cases (93%) were macroadenomas. Cavernous sinus invasion on MRI was noted in 32.2% of cases. Fifteen percent were reoperations. Gross-total resection was achieved in 63.5% of patients, and the median length of stay was 3 days. Surgical complications included postoperative CSF leakage (4.2%), epistaxis (2.7%), cranial nerve palsy (1.0%), worsened vision (1.0%), meningitis (1.0%), stroke (0.8%), hydrocephalus (0.7%), hematoma (0.6%), sinusitis (0.6%), abdominal hematoma or infection (0.4%), carotid artery injury (0.1%), and death (0.3%). Medical complications included transient diabetes insipidus (8.7%), permanent diabetes insipidus (2.4%), bacteremia/sepsis (0.7%), pneumonia (0.3%), and deep venous thrombosis/pulmonary embolism (0.1%). Early readmission and early reoperation were observed in 10.2% and 4.8% of cases, respectively. The most common reasons for early readmission were delayed hyponatremia (4.2%), CSF leakage (1.8%), infection (1.1%), epistaxis (0.7%), and hypocortisolemia (0.1%), while the most common reasons for early reoperation were CSF leakage (2.5%), residual tumor (1.3%), worsened vision (0.6%), infection (0.6%), and hematoma (0.3%). Predictors of complications included increasing tumor diameter, firm tumor consistency, the presence of an intraoperative CSF leak, and use of an extended approach. While not statistically significant, rates of postoperative CSF leakage (5.1% vs 3.4%), early readmission (11.4% vs 9.1%), and early reoperation (5.7% vs 4.0%) decreased from the first half of the cohort to the second half of the cohort.</p><p><strong>Conclusions: </strong>Endoscopic TSS for PAs is associated with low morbidity and mortality, although a number of complications are possible. Readmission and reoperation following eTSS occur less frequently when endocrine readmissions can be averted. The results of this study provide information on the risks associated with eTSS and serve as a guide for neurosurgeons to counsel patients undergoing this procedure.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1035-1047"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584516","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":"Ketamine in neurosurgery: a historical perspective.","authors":"Allie L Sinclair, Gabriel Jelkin, Beatrice Zucca, Charles J Prestigiacomo, Laura B Ngwenya","doi":"10.3171/2026.2.JNS251845","DOIUrl":"10.3171/2026.2.JNS251845","url":null,"abstract":"<p><p>Ketamine, a short-acting anesthetic first synthesized in 1962, has long been surrounded by controversy, particularly regarding its use in neurosurgery. The rise in elective surgeries in the early 20th century spurred the development of new anesthetics. Phencyclidine (PCP) was created, which was effective but caused psychotic features. In response, ketamine, a safer PCP derivative was synthesized. Approved by the FDA in 1970, ketamine was widely used during the Vietnam War and gained favor in pediatric neurosurgery due to its rapid onset, lack of intubation requirement, and smooth recovery. It introduced the concept of \"dissociative anesthesia.\" However, the emergence of newer anesthetics, early concerns about ketamine raising intracranial pressure (ICP), and its association with recreational drug use led to a decline in clinical neurosurgical use. This study explores ketamine's history, misconceptions about its safety, its effects on ICP, and its current neurosurgical applications. Reevaluating ketamine's history and its role could improve outcomes in neurological critical care and lead to a greater awareness that is essential to understanding its potential in neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1096-1104"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584511","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 yield and safety of Remebot robot-assisted stereotactic biopsy: a 496-case retrospective analysis of intracranial lesions.","authors":"Kaishan Wang, Feng Yan, Yaming Wang, Yongzhi Shan, Xiaotong Fan, Sichang Chen, Guoguang Zhao","doi":"10.3171/2026.2.JNS251592","DOIUrl":"https://doi.org/10.3171/2026.2.JNS251592","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to evaluate the diagnostic yield, safety, and workflow advantages of the Remebot system in intracranial stereotactic biopsies.</p><p><strong>Methods: </strong>The authors retrospectively analyzed 496 consecutive patients who underwent Remebot-assisted stereotactic brain biopsy at a single institution between 2023 and 2024. Demographic, clinical, radiological, and pathological data were collected. Logistic regression analysis was used to identify predictors of nondiagnostic biopsy. Model performance was evaluated using McFadden's pseudo-R2 and receiver operating characteristic analysis. Perioperative complications were defined and graded according to the Common Terminology Criteria for Adverse Events (version 5.0).</p><p><strong>Results: </strong>The overall diagnostic yield was 85.9% (426/496), with high-grade glioma (32.7%) and hematological malignancies (20.4%) as the most common pathologies. Multivariate analysis identified deep lesion sampling (OR 0.51, 95% CI 0.27-0.94; p = 0.034) and younger age (OR 0.98, 95% CI 0.97-0.99; p = 0.006) as independent predictors of nondiagnostic results. Sex, lesion location (supratentorial vs infratentorial), and brainstem involvement were not associated with yield. The perioperative complication rate was 1.8% (9/496), with hemorrhage accounting for 77.8% of events. All complications occurred in male patients, predominantly in those with high-grade glioma. The Remebot system demonstrated notable workflow advantages, including integrated planning, automated registration, and compact modular design.</p><p><strong>Conclusions: </strong>Remebot-assisted stereotactic biopsy achieved a high diagnostic yield and low complication rate, comparable with that of international robotic platforms. Deep lesion sampling and younger age were found to increase the risk of nondiagnostic results, whereas sex and lesion location did not. The system's integrated workflow, automated registration, and cost-efficient accessibility broaden its clinical applicability and support its role as a reliable tool for minimally invasive neurosurgical diagnosis.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.8,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148584485","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 postoperative neovascularization after indirect bypass in adult moyamoya disease: a preoperative clinical and perfusion-based model.","authors":"Sang Hyo Lee, Jeong-Mee Park, Bong-Gyu Ryu, Yonghun Song, Seung Bin Sung, Tae Won Choi, Young-Deok Kim, Seung Pil Ban, Jae Seung Bang, Young-Je Son, O-Ki Kwon, Si Un Lee","doi":"10.3171/2026.2.JNS252077","DOIUrl":"10.3171/2026.2.JNS252077","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to identify preoperative clinical, angiographic, and quantitative perfusion predictors of postoperative neovascularization (PNV) after indirect bypass (IB) in adult moyamoya disease (MMD).</p><p><strong>Methods: </strong>The authors retrospectively reviewed 128 hemispheres in 106 adults with MMD who underwent IB at a single institution between January 2018 and December 2024. Preoperative time-to-maximum (Tmax) volumes were obtained from CT perfusion analysis using thresholds of > 4 seconds and > 6 seconds. PNV was evaluated 6 months after surgery using the Matsushima grading system. Multivariable logistic regression analyses were performed to identify independent predictors of favorable PNV in two models, defined as Matsushima grade (MG) A and as MG A or B, respectively. Receiver operating characteristic curve analysis was used to determine optimal cutoff values.</p><p><strong>Results: </strong>At 6 months postoperatively, 38.3% of hemispheres achieved MG A PNV, and 67.2% achieved MG A or B PNV. For MG A PNV, younger age (OR 0.95, 95% CI 0.91-0.99; p = 0.009) and larger preoperative volume of Tmax > 6 seconds (OR 1.022, 95% CI 1.01-1.03; p < 0.001) were significant predictors, with an optimal cutoff value of 33.5 mL for Tmax > 6 seconds (area under the curve [AUC] 0.805, sensitivity 76%, specificity 75%). For MG A or B PNV, transient ischemic attack at presentation (OR 2.90, 95% CI 1.12-7.97; p = 0.033) and larger preoperative volume of Tmax > 4 seconds (OR 1.019, 95% CI 1.01-1.03; p < 0.001) were identified as significant predictors, with an optimal cutoff value of 111.5 mL for Tmax > 4 seconds (AUC 0.817, sensitivity 70%, specificity 93%).</p><p><strong>Conclusions: </strong>In adult MMD, greater preoperative ischemic burden measured by volumes of tissue with Tmax delays > 4 seconds or > 6 seconds predicted favorable PNV after IB. Younger age and transient ischemic attack at presentation were also associated with better PNV. This study highlights the role of perfusion parameters, together with clinical factors, in surgical decision-making and individualized treatment planning.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"925-934"},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471158","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":"Erratum. Refined temporal-to-frontal horn shunting for trapped temporal horn syndrome: long-term outcomes and complication management in a two-center series of 53 patients.","authors":"Xiaohui Ren","doi":"10.3171/2026.6.JNS251203a","DOIUrl":"10.3171/2026.6.JNS251203a","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1252"},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471180","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}