Journal of neurosurgery最新文献

{"title":"Hypofractionated radiosurgery for intracranial arteriovenous malformations: a systematic review and meta-analysis.","authors":"Vinay Jaikumar, Kyungduk Rho, Nicole Nobrega, Ali Haider, Hannah Danziger, Jaims Lim, Muhammad Waqas, Andre Monteiro, Pui Man Rosalind Lai, Jason M Davies, Kenneth V Snyder, Elad I Levy, Dheerendra Prasad, Adnan H Siddiqui","doi":"10.3171/2025.2.JNS242169","DOIUrl":"10.3171/2025.2.JNS242169","url":null,"abstract":"<p><strong>Objective: </strong>Obliteration of intracranial arteriovenous malformations (AVMs) with radiosurgery is challenging because high radiation doses prescribed for better effectiveness can increase procedural risks. To minimize adverse effects, fractionation protocols ensure delivery of equivalent or higher total radiation in manageable doses. Hypofractionated stereotactic radiosurgery (HF-SRS), a fractionation strategy using doses exceeding 2 Gy per fraction, requires fewer treatment sessions. The authors conducted a systematic literature review to meta-analyze potential benefits of HF-SRS compared with conventional fractionation regimens.</p><p><strong>Methods: </strong>PubMed and Embase were searched for literature on \"hypofractionated,\" \"radiosurgery,\" and \"arteriovenous malformations.\" Data including patient and AVM characteristics, procedural details, and outcomes were extracted from eligible studies. Meta-analyses were performed on variables reported by ≥ 3 studies. Subgroup analyses were conducted for photon- and proton-based HF-SRS.</p><p><strong>Results: </strong>The authors included 29 studies comprising 995 patients. For HF-SRS, digital subtraction angiography (DSA) confirmed a 50.1% obliteration rate (95% CI 35.2%-64.9%, I2 = 85.3%) at 41.2 months (95% CI 35.3-48.1 months, I2 = 95%) of follow-up, with an associated 11.1% (95% CI 8.4%-14.5%, I2 = 28.5%) rupture rate, 5.5% (95% CI 3.5%-8.5%, I2 = 0%) new-onset seizure rate, 10.4% (95% CI 6.8%-15.6%, I2 = 41.7%) radionecrosis, and 6% (95% CI 4%-8.9%, I2 = 13.7%) AVM-related mortality. Studies comparing total HF-SRS doses ≥ 35 Gy with < 35 Gy demonstrated trends toward higher rates of DSA-confirmed obliteration (60.9% vs 47.8%, p = 0.57) and radionecrosis (19.9% vs 8.2%, p = 0.02) with higher doses. Similarly, per-fraction doses ≥ 7 Gy showed higher obliteration trends (53.5% vs 44.5%, p = 0.64) and radionecrosis rates (18% vs 6.2%, p = 0.01) compared with < 7-Gy/fraction doses, indicating a dose-response relationship. Photon-based and proton-based HF-SRS resulted in comparable rates of angiographic obliteration (50.7% vs 48%, p = 0.86), follow-up rupture (10.3% vs 9.6%, p = 0.9), and AVM-related mortality (5.4% vs 7.4%, p = 0.5), despite a greater proportion of higher Spetzler-Martin grade AVMs in the photon-based studies (82.2% vs 55.3%, p < 0.01) with lower doses per fraction (7.2 vs 11.1 Gy, p < 0.01).</p><p><strong>Conclusions: </strong>HF-SRS is a promising radiosurgical strategy for AVMs with no statistically significant differences in effectiveness and adverse effects between photon- or proton-based therapies. There is notable heterogeneity in the application of HF-SRS for AVMs, necessitating further investigations with consistent reporting and incorporation of prior, adjuvant, and salvage treatments for AVMs.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"678-689"},"PeriodicalIF":3.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187192","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":"History and current state of neurosurgery in Greece.","authors":"Adamantios Kalogeras, Theodosios Spiliotopoulos, Nathan A Shlobin, Anastasia Tasiou, George A Alexiou, Nikolaos Foroglou, Moschos Fratzoglou, Theofilos S Paleologos, Vasilios Panagiotopoulos, Ioannis Patsalas, Aristeidis Prassas, George Stranjalis, Parmenion P Tsitsopoulos, Konstantinos Vlachos, Spyridon Voulgaris, Gail Rosseau, Kostas N Fountas","doi":"10.3171/2025.2.JNS242902","DOIUrl":"https://doi.org/10.3171/2025.2.JNS242902","url":null,"abstract":"<p><p>There is a global deficit in access to neurosurgical care. Although most of the deficit occurs in low- and middle-income countries, high-income countries can also face similar problems. Greece has experienced challenges in the provision of neurosurgical care due to diverse terrains, socioeconomic inequalities, and deficient health systems. Discussions with key individuals involved in neurosurgical care were conducted to characterize the history and current state of neurosurgery in Greece. Data were collected from Greek hospitals with neurosurgical services and the archives of the Hellenic Neurosurgical Society. A summary of the background of Greece is provided. Then, the ancient and modern history of neurosurgery and the current state of neurosurgery in Greece is described, underscoring important moments and individuals in Greek neurosurgery. This article describes the history and current state of neurosurgery in Greece and yields critical insights to guide the neurosurgical community in developing neurosurgical care in countries that experience similar challenges as Greece.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187191","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":"Outcome metrics for primary endoscopic endonasal surgery for low-risk patients with Cushing's disease: an evidence-based position statement from the Registry of Adenomas of the Pituitary and Related Disorders consortium.","authors":"Michael Karsy, Varun R Kshettry, James J Evans, Garni Barkhoudarian, Won Kim, Donato R Pacione, Paul A Gardner, Juan C Fernandez-Miranda, Carolina G Benjamin, Michael P Catalino, Gabriel Zada, Robert C Rennert, Julie M Silverstein, Kyle Wu, Jamie J Van Gompel, Michael R Chicoine, Andrew S Little","doi":"10.3171/2025.1.JNS241286","DOIUrl":"https://doi.org/10.3171/2025.1.JNS241286","url":null,"abstract":"<p><strong>Objective: </strong>Reports of surgical outcomes for Cushing's disease are mostly limited to single-center experiences by expert surgeons. Therefore, no generalizable surgical outcome metrics for endoscopic endonasal Cushing's disease surgery are available for practitioners to guide quality-improvement efforts. This is potentially problematic, given the high morbidity and excess mortality observed in patients who do not achieve remission. This study proposes a bundle of evidence-based metrics for low-risk patients with Cushing's disease, for whom optimal outcomes would be expected, that focus on the cost efficiency of care and surgical outcomes from multicenter collaboration of US pituitary centers.</p><p><strong>Methods: </strong>The steering committee of the Registry of Adenomas of the Pituitary and Related Disorders (RAPID) consortium proposed the metrics based on available data from 12 US pituitary centers. A benchmarking population of low-risk patients undergoing first-time surgery was identified. Patient characteristics and outcomes were aggregated and analyzed by a data coordinating center. Metrics were reported using 2 approaches.</p><p><strong>Results: </strong>A total of 431 patients from 12 centers who underwent primary endoscopic transsphenoidal surgery from January 1, 2006, to December 31, 2022, were included. There were 227 patients in the low-risk cohort (age < 70 years, BMI < 50, microadenoma, and Knosp grade 0-2). For the cost-efficiency metrics, the mean (SD) length of stay was 3.8 (4.8) midnights, and the percentage of patients readmitted was 11.1%. The rate of disposition to a skilled nursing facility was 2.2%. For surgical outcomes, the rate of postoperative CSF leakage was 1.3%, and the rate of 1-year sustained surgical remission was 81.2%. The rates of permanent and temporary arginine vasopressin deficiencies were 1.8% and 11.9%, respectively. The 75th percentile performance by center was 3.0 midnights for length of stay, 6.3% for 90-day unplanned readmission, < 1% for disposition to a skilled nursing facility, < 1% for CSF leakage, and 92.2% for 1-year sustained remission. The 75th percentile was < 1% for both permanent and temporary arginine vasopressin deficiencies.</p><p><strong>Conclusions: </strong>An evidence-based bundle of metrics in a Cushing's disease patient population at low risk who underwent first-time endoscopic pituitary surgery is proposed. Surgeons can use these metrics to assess and improve the quality of their clinical pathways.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187194","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":"Conservative management of 661 patients with unruptured intracranial aneurysms: an observational study over 4 decades.","authors":"Philippe Dodier, Philip Lederer, Bernhard Ecker, Muhammet Dogan, Elisabeth Strasser, Anna Cho, Dorian Hirschmann, Wei-Te Wang, Christian Dorfer, Lukas Haider, Arthur Hosmann, Andreas Gruber, Gerhard Bavinzski, Karl Rössler, Josa M Frischer","doi":"10.3171/2025.1.JNS241986","DOIUrl":"10.3171/2025.1.JNS241986","url":null,"abstract":"<p><strong>Objective: </strong>The management of unruptured intracranial aneurysms (UIAs) remains controversial, with a scarcity of long-term natural history data on conservative management. Therefore, the authors attempted to identify risk factors for aneurysm rupture in a cohort of consecutive patients with UIAs.</p><p><strong>Methods: </strong>In this retrospective observational study, the authors analyzed 661 patients with 767 exclusively UIAs who were conservatively managed at their tertiary referral center between 1984 and 2020. Patient-specific and aneurysm-specific risk factors for hemorrhage and aneurysm-related death were analyzed, including thresholds for the PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, and site of aneurysm) and ELAPSS (earlier subarachnoid hemorrhage, aneurysm location, age, population, aneurysm size and shape) scores that were set at 8 and 15, respectively, prior to the analyses.</p><p><strong>Results: </strong>The median follow-up in the conservative observation period was 4.1 years, with 42% of the patients observed for ≥ 5 years. The overall aneurysm-related mortality rate was 4.4%. In 23 (3.5%) patients, aneurysm rupture was reported during the conservative observation period, resulting in an overall calculated annual hemorrhage rate of 0.6%. Notably, 87% of the hemorrhages occurred in the first 5 years after diagnosis, whereas no single rupture occurred after 10 years. Aneurysm size and PHASES and ELAPSS scores were independent predictors of hemorrhage. Among patients with a PHASES score < 8 or an ELAPSS score < 15, no aneurysm-related death or aneurysm rupture occurred.</p><p><strong>Conclusions: </strong>The identified PHASES and ELAPSS score thresholds may help identify high-risk patients with UIAs. Individual aneurysm rupture risks must be carefully weighed against center-specific treatment outcomes. For conservatively managed UIAs, lifelong regular follow-up is recommended and seems to be especially important in the first 10 years after diagnosis.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"641-653"},"PeriodicalIF":3.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of perilesional heatsink structures on ablation volumes and symmetry in laser interstitial thermal therapy for the treatment of primary central nervous system tumors.","authors":"Chandler N Berke, Cameron A Rivera, Shovan Bhatia, David Levi, Adham M Khalafallah, Victor M Lu, Kate Stillman, Chase DeLong, Eric Singh, Adam Levy, Ashish H Shah, Ricardo J Komotar, Michael E Ivan","doi":"10.3171/2025.1.JNS241377","DOIUrl":"10.3171/2025.1.JNS241377","url":null,"abstract":"<p><strong>Objective: </strong>Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment for primary CNS tumors. While LITT offers advantages over traditional approaches, perilesional intracranial heatsinks can lead to asymmetrical ablation, impacting patient outcomes. Understanding heatsink effects is crucial for optimizing LITT efficacy.</p><p><strong>Methods: </strong>The authors retrospectively analyzed primary CNS tumors treated with LITT at a single tertiary care center. Ablation outcomes were quantified using the Heatsink Effect Index (HEI), measured on a scale of 0-1 (0 = total symmetry, 1 = complete asymmetry), and extent of ablation (EOA). The heatsink types evaluated were sulci, meninges, vasculature, and CSF spaces, inclusive of ventricles, resection cavities, and CSF cisterns. Statistical analyses were performed to assess the relationship between heatsink proximity and type and ablation outcomes.</p><p><strong>Results: </strong>A total of 99 patients satisfied all selection criteria. The cohort was 53% female, with a mean age of 61 years. Glioblastoma was the most predominant tumor type (78%), followed by low-grade glioma (15%) and meningioma (4%). Heatsink proximity significantly correlated with ablation asymmetry (HEI) (p < 0.001), particularly at the midpoint of the catheter trajectory. The correlation between closest heatsink distance and HEI varied across the different heatsink types, with distance to vasculature and CSF spaces correlating the strongest with ablation asymmetry. When assessing the relationship between EOA and medial HEI during suboptimal ablations (EOA < 100%), a negative correlation was demonstrated, showing improved EOA as HEI was reduced. Optimal cutoff catheter-heatsink distances for predicting ablation asymmetry ranged from 6.6 to 13.0 mm, emphasizing the impact of heatsink proximity on LITT efficacy.</p><p><strong>Conclusions: </strong>This study shows that proximity to heatsinks, especially within a threshold distance of 13.0 mm from the laser catheter, significantly predicts ablation asymmetry and volume in the setting of primary CNS tumors. Vasculature and CSF spaces demonstrate the strongest heatsink effects. Neurosurgeons should consider heatsink effects in pre- and intraoperative planning to optimize LITT outcomes and preserve normal brain tissue.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"818-828"},"PeriodicalIF":3.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132367","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":"Microsurgical management of 883 previously coiled intracranial aneurysms: a systematic review, meta-analysis, and meta-regression of its effectiveness and safety.","authors":"Keng Siang Lee, Oliver Wroe-Wright, John J Y Zhang, Ahilan Kailaya-Vasan, Ramez Kirollos, Julian Han, Pascal Jabbour, Michael T Lawton","doi":"10.3171/2025.2.JNS242565","DOIUrl":"10.3171/2025.2.JNS242565","url":null,"abstract":"<p><strong>Objective: </strong>With the increasing number of intracranial aneurysms (IAs) treated by endovascular coiling, more residual and recurrent IAs are being encountered. This study aimed to evaluate the effectiveness and safety of the microsurgical management of these previously coiled IAs.</p><p><strong>Methods: </strong>Systematic searches of the Medline, Embase, and Cochrane Central databases were performed. The primary outcome was good functional outcome (modified Rankin Scale score 0-2 or Glasgow Outcome Scale score 4-5) and unchanged/improved functional outcomes at the last follow-up. Secondary outcomes included intraoperative rupture, complete occlusion confirmed on imaging, and perioperative complications and death within 30 days.</p><p><strong>Results: </strong>Thirty-nine studies reporting on 874 patients with 883 previously coiled IAs managed by microsurgery were included in the meta-analysis. Of the 883 IAs, 656 (74.3%), 167 (18.9%), 44 (5.0%), and 16 (1.8%) underwent direct clipping, clipping with coil removal, bypass, and trapping, respectively. Forty-five (5.1%), 806 (91.3%), and 32 (3.6%) IAs were classified as Gurian group A, B, and C. IAs were located anteriorly in 88.2% and posteriorly in 11.8%; 45.3% were < 7 mm, 31.3% were 7-12 mm, 14.6% were 13-24 mm, and 8.8% were > 25 mm. The overall mean clinical follow-up duration was 33.7 months. Overall proportions of intraoperative rupture, perioperative stroke, and death were 0.1% (95% CI 0.0%-1.1%, I2 = 25.2%), 8.2% (95% CI 5.85%-11.34%, I2 = 52.8%), and 3.7% (95% CI 2.63%-5.24%, I2 = 0.0%), respectively. The proportions of complete occlusion, good, and improved/unchanged functional outcomes were 97.2% (95% CI 95.82%-98.13%, I2 = 0.0%), 82.9% (95% CI 79.67%-85.69%, I2 = 5.1%), and 92.3% (95% CI 89.27%-94.54%, I2 = 0.0%), respectively. Direct clipping of unruptured anterior circulation IAs was associated with the lowest proportion of intraoperative rupture, perioperative stroke, and death. Direct clipping was also associated with the greatest proportion of complete occlusion, good functional outcome, and improved/unchanged neurological outcome. Microsurgery within 1 month of endovascular coiling and management of Gurian group C IAs were associated with greater proportions of perioperative death.</p><p><strong>Conclusions: </strong>Microsurgical management of previously coiled IAs is an effective and safe strategy in well-selected patients. Important factors to consider in the management of these IAs include the size and location of the IA, rupture status at initial presentation, indication for microsurgery, and type and timing of microsurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"654-667"},"PeriodicalIF":3.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132452","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 patients with poor functional outcome after spontaneous aneurysmal subarachnoid hemorrhage: the predicting subarachnoid hemorrhage long-term outcome score.","authors":"Marie Renaudier, Vincent Degos, Gianluca Pisanu, Benjamin Granger, Lamine Abdennour, Caroline Tabillon, Dany Hijazi, Anne-Laure Boch, Bertrand Mathon, Frédéric Clarençon, Eimad Shotar, Louis Puybasset, Rémy Bernard, Alice Jacquens","doi":"10.3171/2025.2.JNS242210","DOIUrl":"10.3171/2025.2.JNS242210","url":null,"abstract":"<p><strong>Objective: </strong>Subarachnoid hemorrhage (SAH) is a critical condition with high morbidity and mortality. Despite medical advances, predicting functional outcomes 1 year after the hemorrhage remains challenging. The aim of this study was to develop, compare, and validate a predictive score for 1-year functional outcomes after SAH.</p><p><strong>Methods: </strong>This monocentric, retrospective observational study included all adults admitted to a neurosurgical ICU for aneurysmal SAH from 2002 to 2020, excluding moribund patients. The primary endpoint was a poor 1-year functional outcome, defined as a modified Rankin Scale score of 4 to 6. Independent risk factors for poor outcomes were identified using multivariate logistic regression in a derivation cohort. The predicting SAH long-term outcome (PSL) score was compared with the World Federation of Neurosurgical Societies (WFNS), Fisher, and admission bioclinical scores and validated in an independent cohort.</p><p><strong>Results: </strong>In the overall population (n = 1564), 21% experienced poor functional outcomes at 1 year. In the derivation cohort (n = 1095), independent predictors of poor outcomes included age (p < 0.001), WFNS score (p < 0.001), troponin level (p = 0.007), S100β level (p = 0.01), surgical or coiling complications (p < 0.001), incomplete aneurysm exclusion (p = 0.03), and hydrocephalus requiring CSF drainage (p = 0.002). The PSL score achieved an area under the receiver operating characteristic curve (ROC-AUC) of 0.85 (95% CI 0.82-0.88), outperforming other scores. These findings were consistent across various subgroups. In the validation cohort (n = 469), the PSL score achieved an ROC-AUC of 0.80 (95% CI 0.74-0.85), surpassing the WFNS and Fisher scores, with a negative predictive value of 95% (95% CI 94%-97%).</p><p><strong>Conclusions: </strong>The authors developed a simple and effective score to identify predictors of poor 1-year functional outcomes at admission and early after aneurysmal SAH in a large cohort.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"615-623"},"PeriodicalIF":3.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132453","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":"Shedding light on tiny intracranial aneurysms: a retrospective risk assessment.","authors":"Jennifer Sauvigny, Safouh Muzaiek, Patrick Czorlich, Franz L Ricklefs, Maxim Bester, Thomas Sauvigny, Lasse Dührsen","doi":"10.3171/2025.2.JNS242537","DOIUrl":"10.3171/2025.2.JNS242537","url":null,"abstract":"<p><strong>Objective: </strong>Tiny intracranial aneurysms (tiAs) pose challenges in detection and management. Recent advances in neuroimaging have improved the detection rates of these diminutive lesions, yet the decision-making process regarding their treatment remains controversial. While larger aneurysm size is a relevant risk factor for a possible rupture in common risk scores, the rupture of tiAs leading to subarachnoid hemorrhage (SAH) is also reported frequently. However, a heterogeneity in practice exists, and clear guidelines for the treatment of incidental tiAs are lacking. The aim of this study was to investigate clinical decision-making for aneurysm repair by investigating the risk factors for rupture in tiny aneurysms.</p><p><strong>Methods: </strong>This retrospective analysis utilized data from patients admitted to the University Medical Center Hamburg-Eppendorf for aneurysmal SAH (n = 427) between 2010 and 2020 and patients with unruptured intracranial aneurysm (UIAs) discussed by the medical center's aneurysm board (n = 743) between 2012 and 2022. Patients with single tiAs, defined as a maximum diameter of 3 mm, were selected for further analysis. Patient demographics, aneurysm characteristics, and risk factors were compared between the SAH and UIA groups. A modified UIA treatment score (UIATS*) and the PHASES (population, hypertension, age, size of aneurysm, earlier SAH from another aneurysm, site of aneurysm) score were collected in UIA patients and applied retrospectively in SAH patients for the time of admission.</p><p><strong>Results: </strong>The authors identified 79 tiAs in the SAH cohort and 109 tiAs in the UIA cohort. Irregular morphology (OR 4.53, 95% CI 1.84-11.16; p < 0.001) and a high size ratio/aspect ratio (> 3/1.6; OR 14.73, 95% CI 3.55-61.17; p < 0.001) were significantly associated with rupture when comparing tiAs of the SAH and UIA groups. When applying the UIATS* to tiny aneurysms retrospectively, intervention would have been recommended in 20.3% of SAH cases compared with 0.9% of UIA cases (p < 0.001). Comparatively, for nontiny aneurysms, intervention would have been recommended in 33.9% of SAH cases compared with 15.6% of UIA cases (p < 0.001).</p><p><strong>Conclusions: </strong>In the present collective, several ruptured tiAs could be identified. Nevertheless, only a few would have been recommended for treatment. Especially tiAs with irregular morphology and abnormal configurations should be critically evaluated for rupture risk. Current scoring systems provide valuable guidance but should be used in conjunction with individualized, multidisciplinary treatment approaches.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"634-640"},"PeriodicalIF":3.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The origins of neurosurgery at the University of South Florida in Tampa Bay.","authors":"Keaton Piper, Jay I Kumar, Donald Smith, Thomas Freeman, Fernando L Vale, Mark Greenberg, Gene Balis, Harry van Loveren","doi":"10.3171/2025.1.JNS242646","DOIUrl":"https://doi.org/10.3171/2025.1.JNS242646","url":null,"abstract":"<p><p>Academic neurosurgery in Tampa, Florida, had a recent expeditious beginning, ultimately leading to the foundation of the University of South Florida (USF) neurosurgery residency under the tutelage of Dr. David W. Cahill in 1987. In this paper, the authors summarize the important events and people who have made USF neurosurgery possible. Through faculty interviews and literature review, a summary of the history of USF neurosurgery was developed and confirmed by multiple sources. While the USF neurosurgery program is still young, it has made significant regional and national contributions to the field during the couple decades under the guidance of Dr. David Cahill and then Dr. Harry van Loveren. Presented is an account of the faculty, sites, trainees, and important events spanning the history of USF neurosurgery.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132369","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":"Intraoperative neural firing correlates with motor and cognitive features in Parkinson's disease.","authors":"Natasha C Hughes, Danika L Paulo, Michael Zargari, Derek J Doss, Saramati Narasimhan, Robert Shults, Rui Li, Benoit M Dawant, Kaltra Dhima, Hakmook Kang, Travis J Hassell, Tyler J Ball, Dario J Englot, Sarah K Bick","doi":"10.3171/2025.1.JNS241414","DOIUrl":"10.3171/2025.1.JNS241414","url":null,"abstract":"<p><strong>Objective: </strong>During deep brain stimulation (DBS) surgery for Parkinson's disease (PD), intraoperative microelectrode recordings (MERs) are frequently used to determine electrode positioning within the subthalamic nucleus (STN) and globus pallidus internus (GPi). Various patient characteristics might be associated with abnormal STN and GPi firing activity and thus influence electrode placement. In this study, the authors aimed to elucidate the relationship between preoperative dopamine responsiveness or changes in cognitive status and STN or GPi multiunit activity.</p><p><strong>Methods: </strong>This retrospective cohort study included patients with PD undergoing awake STN (n = 74) or GPi (n = 63) DBS surgery with intraoperative MER at a single institution from 2013 to 2021. To control for the lead position, contralateral motor outcomes of each lead were graded using 1-year neurological follow-up notes. Multiunit neural firing activity for each lead was recorded from MER at the location corresponding to lead active contact at the 1-year follow-up assessment. Linear regression models, controlling for disease duration and age, were used to identify associations between multiunit neural firing rates and preoperative dopamine responsiveness, determined by the difference between preoperative motor scores when on medication minus preoperative motor scores when off medication, and between multiunit activity and the pre- to postoperative change in Mini-Mental State Examination scores.</p><p><strong>Results: </strong>Seventy-four patients with 130 STN leads (mean age 61.2 ± 10.4 years) and 63 patients with 110 GPi leads (mean age 62.8 ± 8.6 years) were included. In STN leads with maximum contralateral motor improvement, increased dopamine responsiveness was associated with both the intraoperative firing rate (p = 0.01) and disease duration (p = 0.01). These relationships were not significant in the GPi leads or when looking at leads for which patients experienced suboptimal motor improvement (p > 0.05). In the GPi leads, an increased intraoperative firing rate in electrodes with maximum symptom improvement was associated with declining cognitive status (p = 0.045).</p><p><strong>Conclusions: </strong>These findings suggest patient characteristics that correlate with neural firing rates and influence intraoperative MER, final electrode placement, and patient outcomes, while improving understanding of STN and GPi pathophysiologic mechanisms in PD. Future investigations into other characteristics that might affect STN and GPi intraoperative neurophysiology are warranted.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"718-727"},"PeriodicalIF":3.6,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132451","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}