Journal of neurosurgery最新文献

{"title":"The role of Area Deprivation Index in treatment selection for anterior communicating artery aneurysms.","authors":"Rashad Jabarkheel, Avi A Gajjar, Najib Muhammad, Oliver Y Tang, Samuel B Tomlinson, Josh Golubovsky, Antonio Corral Tarbay, Georgios S Sioutas, Sai Mannam, Alex Vaz, Sonia Ajmera, Sandeep Kandregula, Bryan Pukenas, Omar Choudhri, Brian T Jankowitz, Jan-Karl Burkhardt, Visish M Srinivasan","doi":"10.3171/2025.4.JNS242291","DOIUrl":"https://doi.org/10.3171/2025.4.JNS242291","url":null,"abstract":"<p><strong>Objective: </strong>Patient outcomes in medicine vary significantly when stratified by socioeconomic status (SES). In the cerebrovascular area specifically, rates of treatment of intracranial aneurysms (IAs) and overall outcomes after subarachnoid hemorrhage vary significantly by SES. Less is known about the effect of SES on the selection of seemingly equivocal treatment modalities (microsurgery vs endovascular embolization) for IAs. In this study, the authors examined the impact of SES as measured by the Area Deprivation Index (ADI) on selection of the treatment modality for anterior communicating artery (ACoA) aneurysms, which are readily amenable for either microsurgical or endovascular treatment.</p><p><strong>Methods: </strong>A retrospective study was conducted on 136 consecutively treated patients with ACoA aneurysms, unruptured and ruptured, between August 2016 and February 2023 at a large, urban, academic hospital led by dual-trained neurosurgeons. A retrospective review of patient demographics, comorbidities, aneurysm size, morphology, and treatment selection was performed. Univariable and multivariable logistic regression analysis of treatment selection was conducted in the unruptured context, an elective setting, where socioeconomic factors play a strong role in patient-provider shared decision-making, versus the ruptured context, an emergency setting, where the need for expedient intervention diminishes the weight of socioeconomic considerations.</p><p><strong>Results: </strong>Multivariable logistic regression showed that being a patient in the top 50th ADI percentiles was strongly associated with undergoing microsurgical treatment of an ACoA aneurysm in the unruptured context (OR 10.88, 95% CI 1.37-86.59; p = 0.02). Conversely, in the context of ruptured ACoA aneurysms, ADI was not associated with treatment selection (OR 0.16, 95% CI 0.02-1.27; p = 0.08).</p><p><strong>Conclusions: </strong>ADI significantly impacts treatment selection in the management of unruptured ACoA aneurysms. This study highlights that there might be indirect socioeconomic barriers biasing patients from lower SES backgrounds away from endovascular treatment of unruptured ACoA aneurysms compared with their higher SES counterparts.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":3.5,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663943","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":"Neurosurgical faculty and resident perspectives on collective bargaining efforts by resident physicians in the United States.","authors":"Prateek Agarwal, Mark M Zaki, Rohit Prem Kumar, Maria A Eckmann, William H Shuman, Owoicho Adogwa, Omar A Zalatimo, Clemens M Schirmer, Gregory J Zipfel, Nathan R Selden, John K Ratliff, Russell R Lonser, Katie O Orrico, E Antonio Chiocca","doi":"10.3171/2025.3.JNS243068","DOIUrl":"10.3171/2025.3.JNS243068","url":null,"abstract":"<p><strong>Objective: </strong>Collective bargaining unions frequently represent employees across industries, including healthcare workers such as nurses. In recent years, resident physicians have been increasingly unionizing to improve working conditions and benefits. However, whether resident unionization will benefit or harm neurosurgery training is unclear. This study aimed to ascertain the perspectives of neurosurgical faculty and trainees on collective bargaining efforts by resident physicians in the United States.</p><p><strong>Methods: </strong>A 17-question survey (14 multiple choice, 3 open ended) evaluating respondents' opinions on resident unionization was emailed to lists of 551 faculty members and 1728 neurosurgical trainees (residents and fellows) in the United States. Both lists were extracted from a database maintained by the Society of Neurological Surgeons (SNS). The faculty list consisted of department chairs, residency program directors, and members of the SNS. Categorical variables were analyzed using chi-square tests. All p values < 0.05 were considered significant.</p><p><strong>Results: </strong>There were 405 respondents (17.8% response rate): 182 faculty (33.0%) and 223 trainees (12.9%). Among faculty respondents, 70% opposed or strongly opposed unions, 54% thought they negatively impact patient care, 80% thought they could lead to strikes, and 85% thought alternate channels for voicing resident concerns were adequate. In contrast, among trainees, only 16% opposed or strongly opposed unions, 9% thought they negatively impacted patient care, 27% thought they could lead to strikes, and 38% thought alternate channels for voicing resident concerns were adequate (all p < 0.001). Among institutions with resident unions, 34.2% of faculty and 12.1% of trainees indicated witnessing a negative consequence of unionization, frequently mentioning an inability to make departmental-level changes without applying changes to all resident specialties. Among unionized residents, 84.8% reported a positive result of unionization, including improved pay, protected working hours, parental leave, parking, and educational stipends.</p><p><strong>Conclusions: </strong>The findings revealed a divide between the opinions of trainees and faculty about trainee unionization. Trainees favored resident unionization, while faculty opposed it, highlighting the need for further dialogue to understand the impact of unions on residency training and promote optimal training environments in both unionized and nonunionized environments.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1059-1067"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612200","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":"Minimally invasive surgical evacuation confers a mortality benefit in patients with moderate-sized putaminal hemorrhages.","authors":"Ahmed Kashkoush, Daniel T Lilly, Robert Winkelman, Mark A Davison, Rebecca Achey, Muhammad Shazam Hussain, Joao Gomes, Peter A Rasmussen, Varun R Kshettry, Nina Moore, Mark Bain","doi":"10.3171/2025.3.JNS2565","DOIUrl":"https://doi.org/10.3171/2025.3.JNS2565","url":null,"abstract":"<p><strong>Objective: </strong>Minimally invasive surgical (MIS) evacuation of basal ganglia hemorrhages has not demonstrated efficacy compared with medical management. Prior study from this group has suggested that MIS evacuation of moderate-sized putaminal intracranial hemorrhages (pICHs) using tubular retractors is associated with favorable functional outcomes. The authors hypothesized that postoperative functional outcomes were improved in patients with moderate-sized pICH compared with those of a matched cohort of medically managed patients.</p><p><strong>Methods: </strong>The authors performed a single-center retrospective review of patients admitted with non-lesional pICH between 10 and 50 mL from 2013 to 2024. Patients who underwent MIS evacuation were 1:1 matched to medically managed patients based on volume and ICH score. The main outcome was the utility-weighted modified Rankin Scale (uw-mRS) score obtained within 1 year of admission. Regional pICH extension patterns were evaluated by stereotactically localizing pICH volumes in an anatomical coordinate frame.</p><p><strong>Results: </strong>Sixty-six patients (33 medical and 33 surgical) were included. The uw-mRS score was similar in the medical and surgical cohorts (mean 0.33 vs 0.44, p = 0.174). Mortality was higher in the medically managed group (24% [medical] vs 3% [surgical], p = 0.010). The median ICU length of stay (LOS) was 3 days shorter in the surgical arm (7 vs 4 days, p = 0.045). Anteromedial extension in the region of the anterior limb of the internal capsule and caudate predicted poor outcome (mRS scores 4-6) in surgically managed patients (area under the curve [AUC] 0.74, p = 0.006), while posterior and superior extension in the region of the frontal lobe predicted poor outcomes in medically managed patients (AUC 0.74, p = 0.045). The incremental cost-effectiveness ratio was $68,462.55 per quality-adjusted life year for surgical evacuation compared with medical management.</p><p><strong>Conclusions: </strong>In this study, MIS evacuation of moderate-sized pICHs was associated with improved mortality rates, shorter ICU LOS, and cost-effectiveness. Putaminal ICH morphology can differentially predict functional outcome based on management strategy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612198","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":"Stratification of glioblastoma patient survival based on tumor core and edge metabolomic data.","authors":"Dylan A Goodin, Hunter A Miller, Xinmin Yin, Xiang Zhang, Joseph Chen, Brian J Williams, Hermann B Frieboes","doi":"10.3171/2025.3.JNS242330","DOIUrl":"https://doi.org/10.3171/2025.3.JNS242330","url":null,"abstract":"<p><strong>Objective: </strong>Spatial metabolic differences recently found in glioblastoma (GBM) have been linked to the infiltrating nature of the tumor edge tissue, which is mostly unresectable, and to the tumor core tissue, which resists therapy. The impact of metabolic dysregulation in core and edge GBM tissues on patient survival remains unclear. This study evaluated metabolites obtained from core and edge GBM tissues at the time of resection as biomarkers to risk stratify patients in terms of overall survival (OS).</p><p><strong>Methods: </strong>Paired core and edge tumor samples from 27 patients with glioma obtained after craniotomy were evaluated postsurgery with high-resolution 2D liquid chromatography-mass spectrometry/mass spectrometry, and metabolomic data for grade IV samples (n = 21) were analyzed by Kaplan-Meier survival analysis and univariable and multivariable Cox proportional hazard regression models. GBM patients were stratified into low- and high-risk groups via a linear equation based on log-transformed signal intensities of key metabolites. Risk scores were generated by summing the product of weights and metabolite signal intensities for each patient's tumor. Weights for significant metabolites were calculated by scaling the univariable Cox proportional hazard ratio for each metabolite by the standard error. For risk score validation, OS events were predicted using an Extreme Gradient Boosting model with Linear Booster (XGBL).</p><p><strong>Results: </strong>Kaplan-Meier survival analysis identified 6 significant metabolites in core tissue and 5 in edge tissue, respectively. Key metabolites in core and edge tissue identified through univariable Cox regression analyses combined with covariates were used to generate multivariable Cox regression models, with edge metabolites remaining significant after correction by patient sex and age at resection. Risk scores based on either 4 core or 11 edge metabolites, or the combination of both, with covariates, generated multivariable Cox regression models significantly associated with OS. Risk score derived from core metabolites remained significant after correction by covariates and was validated with XGBL classification model (area under the receiver operating characteristic curve = 0.876).</p><p><strong>Conclusions: </strong>OS of patients with GBM can be stratified based on metabolomic differences between core and edge tumor tissues.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612202","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":"An opportune time for targeted brain arteriovenous malformation therapy.","authors":"Andrew T Hale, Pazhanichamy Kalailingam, Adam J Kundishora, Benjamin C Reeves, Priscilla K Brastianos, Helen A Shih, Rakesh K Jain, MingMing Ning, Christopher J Stapleton, Aman B Patel, Edward R Smith, Paul H Chapman, James D Rabinov, Benjamin P Kleinstiver, Patricia L Musolino, Kristopher T Kahle","doi":"10.3171/2025.4.JNS25260","DOIUrl":"10.3171/2025.4.JNS25260","url":null,"abstract":"","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosurgery Research & Education Foundation Medical Student Summer Research Fellowship applicant trends and impact on future career trajectory.","authors":"Michael R Kann, Shovan Bhatia, Taim Aizooky, Sangami Pugazenthi, Anna L Huguenard, Michael Y Wang, Adam S Arthur, Nitin Agarwal, Gregory J Zipfel","doi":"10.3171/2025.3.JNS241757","DOIUrl":"10.3171/2025.3.JNS241757","url":null,"abstract":"<p><strong>Objective: </strong>The Neurosurgery Research & Education Foundation (NREF) Medical Student Summer Research Fellowship (MSSRF) is a prominent research fellowship offered to medical students. The authors investigated how gender and academic characteristics of the MSSRF applicant pool have evolved since the fellowship's inception. Likewise, they evaluated the impact of the MSSRF on career progression, scholarly productivity, and subsequent grant funding within neurosurgery.</p><p><strong>Methods: </strong>A list of MSSRF awardees (2008-2023) and nonawardee applicants (2015-2023) was provided by the NREF. Demographic and career progression variables were obtained through publicly available platforms, and scholarly productivity metrics were collected using Clarivate Web of Science. The Fisher's exact test was used to compare categorical variables, the Mann-Whitney U-test was used to compare continuous variables, and the Mann-Kendall test was used to assess trends. Binary logistic regression was utilized to explore factors associated with matching into neurosurgery.</p><p><strong>Results: </strong>A total of 297 awardees from 2008 to 2023, 183 awardees from 2015 to 2023, and 355 nonawardees from 2015 to 2023 were included. A greater percentage of awardees attended a top 20 medical school than nonawardees (p = 0.002). There was a statistically significant upward trend in the percentage of female awardees since 2010 (p = 0.01). Between 2015 and 2023, there was no difference in the percentage of awardees who matched into neurosurgery compared to nonawardees (60.5% vs 50.2%, p = 0.07), but awardees matched into better Doximity-ranked neurosurgery residency programs (p = 0.04). While there was no difference in the number of total publications or first author publications before residency between awardees and nonawardees who matched into neurosurgery since 2015, awardees had a higher h-index (5.0 vs 4.0, p = 0.03). Specifically among awardees who pursued neurosurgery since 2008, there was a statistically significant upward trend in the median number of total publications before residency (p < 0.001), first author publications (p = 0.001), and h-index (p = 0.007). Among neurosurgery attending physicians who received MSSRF awards, 64.7% practiced in an academic setting. Across academic neurosurgery attending physicians who received MSSRF awards, the ratio of NREF MSSRF award dollars to subsequent National Institutes of Health (NIH) grant funding dollars was $1:$9.05.</p><p><strong>Conclusions: </strong>The NREF MSSRF is associated with high-quality research and strong academic productivity among aspiring medical students, with a high proportion of awardees pursuing neurosurgery and matching into top-ranked residency programs. Likewise, this early-career fellowship has a substantial return on investment in terms of subsequent NIH grant funding.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1096-1107"},"PeriodicalIF":3.6,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612199","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":"Awake surgery for IDH-mutant grade 2 glioma involving the corpus callosum: long-term onco-functional results after callosectomy in 157 consecutive patients.","authors":"Hugues Duffau","doi":"10.3171/2025.3.JNS25145","DOIUrl":"https://doi.org/10.3171/2025.3.JNS25145","url":null,"abstract":"<p><strong>Objective: </strong>Because low-grade glioma (LGG) frequently migrates along the white matter pathways, it may involve the corpus callosum (CC) with possible contralateral diffusion. Contrary to glioblastoma, resection of CC invaded by LGG is poorly documented. Here, a unique experience of 157 patients who underwent awake surgery (AS) for an LGG within the CC is reported to investigate the long-term onco-functional results, including return to work (RTW), after completion of callosectomy.</p><p><strong>Methods: </strong>Patients who underwent AS with functional-based resection by the author for an isocitrate dehydrogenase (IDH)-mutant grade 2 glioma infiltrating the CC were selected (June 1997 through December 2023). Functional and oncological results were analyzed by comparing totally resected LGG (group 1) versus incompletely removed LGG (group 2).</p><p><strong>Results: </strong>In total, 231 AS procedures were performed in 157 consecutive patients (85 males [54.1%], mean ± SD age 36.9 ± 10.1 years). Of these procedures, LGG was discovered due to epilepsy in 117 patients (74.5%) (36 incidentalomas). The mean preoperative Karnofsky performance status (KPS) score was 94 ± 6.6, with 128 working patients (81.5%). There were 150 unilateral (95.5%) fronto-cingulo-callosal or parieto-cingulo-callosal or cingulo-callosal gliomas (88 left [56%] and 62 right [39.5%]) and 7 bifronto-callosal gliomas (4.5%). The mean preoperative tumor volume was 57.1 ± 47.8 cm3. One patient (0.63%) had a persistent postoperative (language) impairment. The mean postoperative KPS score was 94.6 ± 6.1, and 96.8% of patients had RTW. The mean extent of resection was 95% ± 7.9%, with 75 (supra)total resections (47.8%) (group 1) and 82 incomplete resections (52.2%) (group 2). The mean postoperative tumor volume was 4.2 ± 8.6 cm3, with a residue involving the CC less frequently than the hemisphere(s) (p < 0.0001). There were 57 IDH-mutated astrocytomas (36.3%) and 100 oligodendrogliomas (63.7%). Twenty-five patients (15.9%) received early adjuvant treatment, and 74 patients (47.1%) underwent subsequent AS. In group 2, preoperatively, there was a higher rate of intractable seizures (p = 0.009) related to a lower mean KPS score (p = 0.0002), with a greater tumor volume (p = 0.023). Unilateral fronto-cingulo-callosal LGGs were resected more completely than other gliomas (p = 0.031). A residue within the CC was correlated with a decreased proportion of reoperation (p = 0.01) and a shorter overall survival (OS) (p = 0.0002). In the full cohort, the mean follow-up was 9.8 ± 5 years, with an OS rate of 80.9% and median OS of 20 years.</p><p><strong>Conclusion: </strong>This is the first surgical experience of LGG involving the CC resected using AS in the molecular era. The results after callosectomy show a great proportion of functional preservation and RTW, with longer OS.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612197","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":"Recurrence of trigeminal neuralgia after microvascular decompression: a systematic histopathological evaluation of Teflon granuloma.","authors":"Filipe Wolff Fernandes, Christine Dorothee Schmeitz, Christian Hartmann, Joachim K Krauss","doi":"10.3171/2025.3.JNS241949","DOIUrl":"https://doi.org/10.3171/2025.3.JNS241949","url":null,"abstract":"<p><strong>Objective: </strong>Teflon granuloma is one of the possible causes of recurrence in patients with trigeminal neuralgia (TN) who undergo successful microvascular decompression (MVD). The incidence of Teflon granuloma has been variable and the pathophysiology and mechanisms for recurrence have not been well defined. The aim of this study was to characterize the histological features of Teflon granulomas and correlate their occurrence with clinical and intraoperative findings.</p><p><strong>Methods: </strong>Histopathological studies were available for 14 specimens from 13 patients over a 15-year period. Histopathological data and clinical findings were analyzed, and correlation analyses were performed.</p><p><strong>Results: </strong>The mean time until recurrence was 24 months after the index MVD. In 6 instances, the distribution of pain had progressed to an adjacent area, mostly from V2 to V2/V3. All samples showed scar tissue adjacent to the birefringent Teflon filaments, which were embedded between enlarged collagenous fibers. The full configuration of foreign body granuloma with Teflon-adherent giant cells and distinct lymphocytic infiltrates was evident in 10 of 13 instances. Siderophages were found in 4 of 13 instances and microcalcifications occurred in 5 of 13 instances. Notably, the presence of macrophages and siderophages correlated with a longer time to recurrence, suggesting an ongoing inflammatory reaction.</p><p><strong>Conclusions: </strong>This study highlights differences in histopathological findings over time and their possible relevance in the development of Teflon granuloma. While other factors need to be considered for the clinical manifestations of TN recurrence, according to the histopathological findings described here, preventive measures might be considered.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":3.5,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144612201","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":"Comparative assessment of stereoelectroencephalography and subdural electrodes in invasive epilepsy monitoring:\u2028a systematic review and meta-analysis.","authors":"Josh Bandopadhay, Nolan Rizzo, Caroline Hanan, Ahmed T Massoud, Pavel Pichardo-Rojas, Yoshua Esquenazi, Manish N Shah","doi":"10.3171/2025.3.JNS243188","DOIUrl":"https://doi.org/10.3171/2025.3.JNS243188","url":null,"abstract":"<p><strong>Objective: </strong>Intracranial electrographic localization of seizure onset zones can guide surgical planning for patients with pharmacoresistant epilepsy. Stereoelectroencephalography (SEEG) and subdural electrode (SDE) monitoring are the two primary intracranial seizure onset zone localization methods. However, the limited availability of data has made it challenging to directly compare the two methods since they have become used contemporaneously. Therefore, the aim of this study was to comprehensively compare the safety and seizure outcome profiles of SEEG and SDE monitoring by performing a double-arm meta-analysis.</p><p><strong>Methods: </strong>A literature search was conducted using PubMed, Embase, and Cochrane to identify studies comparing SEEG and SDE in patients with pharmacoresistant epilepsy. Only double-arm studies that presented quantitative primary data about seizure outcomes were included. Eligible studies were also assessed for complication rates as a secondary outcome measure. A subgroup analysis was conducted based on age (pediatric only, general, and older cohorts).</p><p><strong>Results: </strong>Of 233 initially screened unique studies, 15 met inclusion criteria, comprising a total of 1632 patients who underwent SEEG and 1482 patients who underwent SDE monitoring. For all included patients, the rate of favorable seizure outcome was greater for SEEG than for SDE (RR 1.14, 95% CI 1.02-1.27; p = 0.02), and the subgroup analysis based on age demonstrated significantly improved seizure outcomes in the general cohort (RR 1.14, 95% CI 1.00-1.30; p = 0.05) with no significant differences in treatment effect between subgroups (p = 0.92). Regarding safety, SEEG had a lower complication rate than SDE in an analysis of all included patients (RR 0.49, 95% CI 0.37-0.66; p < 0.00001), with the subgroup analysis revealing significantly lower complication rates in pediatric (RR 0.28, 95% CI 0.13-0.61; p = 0.001) and general (RR 0.54, 95% CI 0.40-0.74; p = 0.0001) cohorts, with no significant differences in treatment effect between age subgroups (p = 0.29).</p><p><strong>Conclusions: </strong>SEEG provides a significantly higher likelihood of favorable seizure outcomes, and a lower complication rate, compared with SDE. However, the efficacy and safety advantages of SEEG were less pronounced in pediatric and older patients, suggesting that age-specific factors could influence the comparative effectiveness of these monitoring techniques. These findings underscore the importance of tailored approaches to intracranial monitoring based on patient demographics and risk profiles.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564842","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 relationship between lesion overlap with automatically segmented structures and treatment outcomes following MR-guided focused ultrasound thalamotomy for tremor.","authors":"Yoshiki Ito, Satoshi Maesawa, Sachiko Kato, Takahiko Tsugawa, Daisuke Nakatsubo, Takafumi Tanei, Tomotaka Ishizaki, Manabu Mutoh, Miki Hashida, Takahiro Suzuki, Takashi Tsuboi, Masashi Suzuki, Masahisa Katsuno, Ryuta Saito","doi":"10.3171/2025.3.JNS241995","DOIUrl":"10.3171/2025.3.JNS241995","url":null,"abstract":"<p><strong>Objective: </strong>Optimal lesioning is essential for successful MR-guided focused ultrasound (MRgFUS) thalamotomies targeting the ventral intermediate nucleus (Vim) for tremors. This study aimed to evaluate the relationships between postoperative lesions that overlapped with the Vim and surrounding structures segmented automatically and the treatment outcomes.</p><p><strong>Methods: </strong>This study included 48 patients who underwent MRgFUS thalamotomy targeting the Vim for essential tremors. The Clinical Rating Scale for Tremor (CRST) score was examined preoperatively as well as 1 week, 3 months, and 12 months postoperatively. Adverse effects were also assessed 1 month postoperatively. Using automatic segmentation software and fiber tracking software, the authors retrospectively segmented the Vim and surrounding structures, including the internal capsule (IC), ventrocaudal nucleus (Vc), zona incerta (ZI), and dentato-rubro-thalamic tract (DRTT), using preoperative images. Additionally, they manually delineated the coagulated lesions using images taken immediately after MRgFUS thalamotomy. The relationships between the volume and location of lesions overlapping with these structures, CRST improvement rates, and the presence of adverse effects were examined.</p><p><strong>Results: </strong>The mean thalamotomy volume was 0.076 ± 0.042 cm3 (median 0.085 cm3). The median improvement in the CRST score in the affected upper limb at 12 months postoperatively was 68.8%. Although no correlation was observed between lesion volume and CRST improvement at 1 week postoperatively, a positive correlation was observed between lesion volume and CRST improvement at 3 and 12 months. At 12 months, the authors observed a moderate correlation between the volume of the lesions overlapping with the Vim and improvement in the CRST score. A slightly stronger correlation was observed between the percentage of the lesion volume and the Vim. No correlation was found between lesion volume and improvements in the IC, Vc, ZI, DRTT, or CRST score. However, the authors found that both total lesion volume and the volume of lesion within the IC were significantly associated with gait imbalance.</p><p><strong>Conclusions: </strong>The volume of the lesions immediately after MRgFUS thalamotomy was correlated with improvements in tremor during long-term follow-up. Furthermore, larger lesions within the automatically segmented Vim were associated with better outcomes. This finding supports the usefulness of the method. In contrast, gait imbalance is more likely to occur with larger lesion volumes and may be associated with IC damage.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"960-969"},"PeriodicalIF":3.6,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564883","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}