Journal of neurosurgery最新文献

{"title":"Dusting off the personal archives of Salomón Hakim: unveiling the mind behind normal pressure hydrocephalus.","authors":"Alejandra Ramírez-Romero, Alexandra Ramos-Márquez, Diego F Gómez, Juan F Ramón, Edgar G Ordóñez-Rubiano, Fernando Hakim","doi":"10.3171/2026.2.JNS251746","DOIUrl":"https://doi.org/10.3171/2026.2.JNS251746","url":null,"abstract":"<p><p>Dr. Salomón Hakim (1922-2011), a Colombian physician of Lebanese descent, is widely known for leading a paradigm shift in neurosurgery. In a landmark contribution to neurological medicine, he was the first to identify and characterize a previously unrecognized clinical entity now known as normal pressure hydrocephalus, or Hakim's syndrome, marking a pivotal moment in modern understanding of the disease. Dr. Salomón Hakim was inspired by his father and, since childhood, increasingly curious about physics and the natural sciences. This curiosity led him to develop abilities that would later contribute to valuable advances in medicine and neurosurgery. His interests through early life were conveyed in what he called the \"world's largest lab: the human body.\" Through hard work, Dr. Hakim left a legacy and intellectual heritage that has saved and improved thousands of lives. The work herein aims to share unedited and previously unpublished personal and family archives provided by his son, Fernando Hakim, showcasing Dr. Hakim's valuable contribution to history from the first identified cases of normal pressure hydrocephalus to the creation of Hakim's valve, as well as its current impact.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471189","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":"Pituitary adenomas with subarachnoid invasion: clinical characteristics, radiographic features, surgical management, and outcomes.","authors":"Jonathan B Lamano, Matei A Banu, Christine K Lee, A Sofia Alvarez, Ali Palejwala, Vladimir A Ljubimov, Karam P Asmaro, Enrico Gambatesa, Felipe Constanzo, Byron Hontiveros, Adrian J Rodrigues, Vera Vigo, Juan C Fernandez-Miranda","doi":"10.3171/2026.2.JNS251912","DOIUrl":"10.3171/2026.2.JNS251912","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;A subset of pituitary adenomas invade the subarachnoid space, encase critical neurovascular structures, and portend significant surgical morbidity. Resection of these lesions requires a modified surgical approach involving an expanded bony exposure and meticulous microsurgical dissection to avoid injury to the involved neurovascular structures. The goal of this study was to elucidate the clinical and radiographic features of subarachnoid adenomas and to characterize the outcomes after resection of these challenging tumors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Data were collected from 436 consecutive pituitary adenomas that underwent endoscopic endonasal approaches (EEAs), combined EEA/open transcranial approaches, and open transcranial approaches for tumor resection from 2018 to 2024. Clinical features, imaging characteristics, and clinical outcomes were compared across tumors with and without subarachnoid invasion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Subarachnoid invasion was identified in 8% of pituitary adenomas that underwent resection. Compared to adenomas without subarachnoid invasion, subarachnoid adenomas demonstrated increased nodular invasion, subarachnoid vessel encasement, and tumor size on imaging. Prior surgical intervention and corticotroph/lactotroph histology were significant risk factors for subarachnoid invasion. EEA was the primary surgical approach utilized for resection (80%), although combined EEA/open transcranial (14%) and open transcranial approaches (6%) were also utilized for subarachnoid adenomas. Gross-total resection rates were lower for subarachnoid adenomas (49% vs 89%, p &lt; 0.00001), and patients with subarachnoid adenomas were more likely to require additional interventions (40% vs 13%, p &lt; 0.0001). Tumors with subarachnoid invasion were also associated with increased postoperative hematomas (p = 0.05), perforator infarcts (p &lt; 0.01), and postoperative hydrocephalus requiring shunt placement (p &lt; 0.001). In addition, subarachnoid adenomas were associated with increased rates of permanent vasopressin deficiency (p &lt; 0.01) and adrenal insufficiency requiring permanent hormone replacement (p = 0.02). Based on multivariate analysis, the NETS score was developed to preoperatively predict subarachnoid invasion, incorporating nodular invasion (2 points), subarachnoid vessel encasement (2 points), maximum tumor diameter &gt; 20 mm (1 point), and history of prior surgical intervention (1 point). NETS scores ≥ 3 demonstrated 91% sensitivity and 99% negative predictive value for subarachnoid invasion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Subarachnoid adenomas are associated with high morbidity due to their close association with critical neurovascular structures. Invasive tumor biology and prior arachnoid disruption likely contribute to the nodular invasion and subarachnoid vessel encasement that are characteristic of these challenging tumors. The NETS score is a highly sensitive predictive score that can ","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1057-1068"},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471160","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":"Clinical outcomes following transposition of the lateral femoral cutaneous nerve for meralgia paresthetica: a prospective case series.","authors":"Darius Ansari, Amruth K V Addanki, Asma Eslami, Amgad S Hanna","doi":"10.3171/2026.2.JNS251875","DOIUrl":"10.3171/2026.2.JNS251875","url":null,"abstract":"<p><strong>Objective: </strong>Meralgia paresthetica (MP) is a neuropathy of the lateral femoral cutaneous nerve (LFCN) manifested by burning pain, allodynia, and sensory loss in the anterolateral thigh. While simple decompression is commonly performed in patients who do not respond to nonoperative measures, LFCN transposition is an alternative technique for which rates of symptomatic relief and surgical complications are presently poorly understood. The authors report the largest prospective case series of outcomes from a series of consecutive patients who underwent LFCN transposition for refractory MP.</p><p><strong>Methods: </strong>Patients with idiopathic MP who underwent LFCN transposition by a single surgeon between 2017 and 2024 were prospectively recruited for the study and followed up for a minimum of 1 year postoperatively. Patients with prior ipsilateral decompression or traumatic/iatrogenic etiology were excluded. The primary outcome was improvement in preoperative symptoms, including pain by numeric rating scale (NRS), burning, allodynia, and hypesthesia. Secondary outcomes included rates of postoperative complications.</p><p><strong>Results: </strong>The authors identified 51 surgically treated patients, of whom 37 met final inclusion criteria. The mean age was 52.5 ± 10.7 years, and the mean BMI was 34.1 ± 7.3 kg/m2. Preoperatively, 73.0% of patients reported burning, 56.8% reported allodynia, and 97.3% had hypesthesia. The mean total operative duration was 116.8 minutes with a skin-to-nerve time of 8.5 minutes. At a mean follow-up of 14.9 months, 66.7% of patients experienced resolution or improvement in burning, 61.9% had improvement in allodynia, and 47.2% reported improved hypesthesia. The mean reduction in the NRS pain score was 6.5 ± 2.8 points, with 89.2% of patients reporting improvement in ≥ 50% of preoperative pain by the final follow-up.</p><p><strong>Conclusions: </strong>In the largest prospective study of LFCN transposition to date, patients with refractory noniatrogenic MP experienced meaningful improvement in preoperative symptoms, with the most common postsurgical complication being superficial surgical site infection managed nonoperatively.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1241-1251"},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471210","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":"Minor stroke, major stakes: impact of procedure duration on thrombectomy outcomes in minor stroke.","authors":"Rahim Abo Kasem, Bachar El Baba, Tianwen Ma, Rebecca Zelmanovich, Aqueel Pabaney, Roy Raheb Khelo, Francesca Giraudo, Ariana Chacon, Katherine Chandler, Sameh Samir Elawady, Reda Chalhoub, Brian M Howard, Michael R Levitt, Ramesh Grandhi, Justin Mascitelli, Charles Michael Cawley, Feras Akbik, Zvipo Chisango, Stacey Quintero Wolfe, Joon-Tae Kim, Pascal Jabbour, Shinichi Yoshimura, Ilko Maier, Christopher S Ogilvy, Mohamad Ezzeldin, Marios-Nikos Psychogios, Fazeel Siddiqui, Pedro Navia, Nitin Goyal, Adam S Arthur, Daniele G Romano, Isabel Fragata, Ergun Daglioglu, David Altschul, Min S Park, Roberto Crosa, Waleed Brinjikji, Mark Moss, Justin Dye, Ali Alaraj, Peter Kan, Kaustubh Limaye, Maxim Mokin, Robert M Starke, Alejandro M Spiotta, Jonathan A Grossberg, Ali M Alawieh","doi":"10.3171/2026.2.JNS252558","DOIUrl":"10.3171/2026.2.JNS252558","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular thrombectomy (EVT) for acute large-vessel occlusion stroke is well established, yet its role in patients presenting with minor stroke symptoms (National Institutes of Health Stroke Scale [NIHSS] score < 6) remains unclear. Prior studies have not accounted for intraprocedural factors that may influence outcomes in this subgroup.</p><p><strong>Methods: </strong>The authors analyzed 5693 patients from the STAR (Stroke and Thrombectomy and Aneurysm Registry), including 398 with low NIHSS scores, to evaluate the association between procedure time (PT) and outcomes. Among patients with low NIHSS scores, propensity score matching was used to compare outcomes between those with PT ≤ 35 versus > 35 minutes, a cutoff defined using receiver operating characteristic curve analysis. The authors performed a meta-analysis of studies reporting best medical management (BMM) outcomes in patients with low NIHSS scores. To compare these with EVT-treated patients, a matched BMM comparator cohort using stratification on pooled baseline characteristics was constructed. Outcomes included 90-day functional independence (modified Rankin Scale [mRS] scores 0-2), intracranial hemorrhage, and mortality.</p><p><strong>Results: </strong>PT had a stronger negative effect on outcomes in patients with low NIHSS scores compared with those with high scores, with a steeper decline in functional independence per minute of PT (slope: -0.45% vs -0.21%; p = 0.03 for interaction). Among patients with low scores, PT ≤ 35 minutes was associated with higher 90-day functional independence compared with the propensity score-matching cohort with PT > 35 minutes (82.6% vs 59.0%, p < 0.001). When benchmarked against BMM (75.2% mRS scores 0-2), patients undergoing EVT within 35 minutes had superior outcomes (85.1%, p = 0.047). In contrast, EVT with PT > 35 minutes resulted in worse outcomes than BMM (mRS scores 0-2: 59.8%, p = 0.008). The number needed to treat for PT ≤ 35 minutes was 10, whereas PT > 35 minutes yielded a number needed to harm of 6.</p><p><strong>Conclusions: </strong>PT critically modulates the benefit of EVT in minor stroke. While efficient EVT yields better outcomes than BMM, prolonged procedures are associated with harm. These findings may explain prior inconsistent evidence on EVT in patients with low NIHSS scores and underscore the need to individualize procedural thresholds in this population.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"979-990"},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471199","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":"Clinicopathological evaluation of risk factors for recurrence in craniopharyngioma.","authors":"Jong Ha Hwang, Jae-Kyung Won, Sun Mo Nam, Min-Sung Kim, Jung Hee Kim, Ji Hoon Phi, Chul-Kee Park, Seung-Ki Kim, Yong Hwy Kim","doi":"10.3171/2026.2.JNS252017","DOIUrl":"10.3171/2026.2.JNS252017","url":null,"abstract":"<p><strong>Objective: </strong>Craniopharyngiomas are benign tumors that often exhibit aggressive clinical behavior. The aim of this study was to evaluate long-term surgical outcomes, identify risk factors for recurrence, determine predictors of subtotal resection (STR), and characterize multiple recurrence patterns to optimize treatment strategies.</p><p><strong>Methods: </strong>The authors retrospectively analyzed 269 craniopharyngioma surgeries performed in 225 patients between 2010 and 2024, with a median follow-up of 73.0 months. Each surgery was classified as primary, first recurrence, second recurrence, or third and subsequent recurrences. Second recurrences onward were excluded from the main risk factor analysis for recurrence and analyzed only when characterizing features of multiple recurrences. Accordingly, the first recurrence group was labeled as the \"recurrent group\" for the main comparative analyses. Clinical characteristics, radiological features, surgical outcomes, and neuroendocrinological results were evaluated. Ki-67 indices were assessed in 223 cases using immunohistochemistry.</p><p><strong>Results: </strong>Of the 269 craniopharyngioma surgeries, 181 were primary, 60 were for first recurrence, and 28 were for multiple recurrences. The 5-year recurrence rate was 27.9%, with gross-total resection achieved in 86.2% of cases. In primary tumors, Kaplan-Meier analysis identified STR as a significant predictor of recurrence, while pediatric onset and large tumor volume were potential risk factors. In the recurrent group, large tumor volume was the only factor associated with recurrence. Multivariable analysis confirmed STR (HR 3.60, 95% CI 1.56-8.33) and pediatric onset (HR 2.00, 95% CI 1.02-3.93) as independent predictors of recurrence in primary craniopharyngioma. Vascular encasement was a significant predictor of STR (OR 3.97, 95% CI 1.15-13.7). Endocrine function was maintained in 31.1% of cases with stalk preservation, without increased recurrence risk. Ki-67 indices showed weak correlation with recurrence. Cases with multiple recurrences demonstrated progressive patterns of declining gross-total resection rates and shorter recurrence intervals.</p><p><strong>Conclusions: </strong>Extent of resection was an independent risk factor for craniopharyngioma recurrence, with pediatric patients undergoing STR representing a particularly high-risk group. The Ki-67 index was not a reliable predictor of recurrence. Multiple recurrences demonstrated a progressive trend of increasing recurrence rates and shortening recurrence intervals. These findings provide important insights for treatment planning and patient counseling in the management of craniopharyngioma.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1023-1034"},"PeriodicalIF":3.8,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471145","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":"Skull base revascularization corridors to the high cervical, petrous, and cavernous internal carotid artery: microsurgical anatomy for optimizing surgical exposure.","authors":"Tufan Agah Kartum, Levent Aydın, Barış Küçükyürük, Necmettin Tanriover","doi":"10.3171/2026.2.JNS252834","DOIUrl":"10.3171/2026.2.JNS252834","url":null,"abstract":"<p><strong>Objective: </strong>Revascularization enables the total removal of skull base tumors encasing the internal carotid artery (ICA) and can be used to treat complex aneurysms requiring parent artery occlusion when clipping is unfeasible. Authors of this study aimed to analyze the microsurgical anatomy involved in revascularization procedures involving the high cervical, petrous, and cavernous segments of the ICA in relation to the anterior circulation, with special emphasis on various skull base approaches to optimize the surgical exposure. They also aimed to assess the various surgical corridors used in revascularization procedures by incorporating necessary modifications to standard skull base approaches.</p><p><strong>Methods: </strong>Anterolateral skull base approaches were performed on 6 formalin-fixed, silicone-injected cadaveric human heads (12 sides). Skull base approaches, their combinations, and additional modifications were examined in terms of their ability to provide optimal access to donor and recipient arteries, distinct bypass segments, and clip placement through a single surgical corridor.</p><p><strong>Results: </strong>Resection of the vaginal process of the tympanic part of the temporal bone after mobilization of the lateral pterygoid muscle and the mandibular condyle provided access to the distal part of the high cervical ICA and the initial posterior vertical segment of the petrous ICA. Additional removal of the styloid process increased access to the anastomotic site of the high cervical and petrous segments of the ICA, as well as the extracranial courses of the lower cranial nerves. The anterior petrosectomy offered broad access to the horizontal segment of the petrous ICA, while the anterior clinoidectomy provided extensive exposure of the clinoidal and supraclinoid ophthalmic ICA segments.</p><p><strong>Conclusions: </strong>An optimized surgical exposure achieved through targeted skull base modifications may allow safe anastomosis and adequate clipping room on the high cervical, petrous, cavernous, and supraclinoid ICA segments. Targeted skull base approaches establish reproducible and functionally robust corridors for bypass procedures involving the entire length of the ICA and the anterior circulation.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1003-1012"},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421874","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":"Low-frequency bipolar versus high-frequency monopolar cortical and subcortical motor mapping in craniotomies for brain tumors.","authors":"William D Chow, Ali Gharibi Loron, Michael B Keough, Noor Malik, Hyo Bin You, Bobby Do, Jenna Schwartz, Charles Reilly, Megan M J Bauman, Charlotte E Michaelcheck, Ernest M Hoffman, Ian F Parney","doi":"10.3171/2026.1.JNS251897","DOIUrl":"10.3171/2026.1.JNS251897","url":null,"abstract":"<p><strong>Objective: </strong>Maximal safe resection of intra-axial brain tumors near the motor cortex is aided by intraoperative motor mapping. Here, the authors compared outcomes in patients undergoing either low-frequency bipolar stimulation (LFBS) or high-frequency monopolar stimulation (HFMS) for cortical and/or subcortical motor mapping during brain tumor resection.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing an asleep craniotomy with motor mapping or an awake craniotomy with motor and speech mapping with a single surgeon was performed. Three cohorts were compared: 1) asleep LFBS (AsLFBS), 2) awake LFBS (AwLFBS; motor + speech mapping), and 3) asleep HFMS. HFMS mapping was not used for awake craniotomies.</p><p><strong>Results: </strong>A total of 284 patients who underwent 300 craniotomies with motor mapping were identified. No significant differences in permanent neurological deficits (p = 0.377) or extent of resection (EOR) of nonenhancing tumors (p = 0.453) were identified between LFBS or HFMS motor mapping cases. Both EOR (92.7% vs 83.5%, p = 0.035) and permanent neurological deficits (7.6% vs 3.3%) occurred more frequently in enhancing tumors with LFBS, although the latter was not statistically significant. HFMS was associated with higher rates of subcortical motor pathway identification (p = 0.001) and fewer total intraoperative seizures (p = 0.003) compared with LFBS. Previous resection (HR 0.46, p = 0.003) and a higher cortical threshold (HR 0.95, p = 0.023) were significantly associated with longer survival, while preoperative aphasia (HR 2.24, p = 0.022), hospital length of stay (HR 1.1, p = 0.005), an insular-based tumor (HR 3.5, p = 0.021), and a histological diagnosis of glioblastoma (HR 2.9, p = 0.001) were negative predictors. Interestingly, overall FLAIR EOR was significantly associated with a marginally decreased overall survival (HR 1.01, p = 0.011).</p><p><strong>Conclusions: </strong>No significant differences in postoperative neurological deficits were found between LFBS and HFMS paradigms. HFMS may identify subcortical motor fibers more reliably while resulting in significantly fewer intraoperative seizures. Although LFBS was associated with greater EOR of contrast-enhancing tumors, it may also be associated with higher rates of postoperative deficits, perhaps reflecting less reliable identification of subcortical motor fibers.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1141-1150"},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421844","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":"Correlation between resumption of employment and overall survival following awake mapping-based surgery for IDH-mutant grade 2 glioma: a consecutive series with 515 patients.","authors":"Hugues Duffau","doi":"10.3171/2026.2.JNS252614","DOIUrl":"10.3171/2026.2.JNS252614","url":null,"abstract":"<p><strong>Objective: </strong>Although the life expectancy after surgery for IDH-mutant grade 2 glioma (G2G) is now approximately 20 years, the resumption of postresection employment has received little attention. The aim of this study was to identify factors associated with return to work (RTW) following awake mapping-guided resection and its potential impact on long-term outcomes in a homogeneous cohort of patients with G2G.</p><p><strong>Methods: </strong>Patients with G2G who were employed before surgery and had ≥ 2 years of postoperative follow-up were identified from a prospective database of connectome-based awake surgical cases performed by the author between June 1997 and September 2023. Patients who were able to RTW were compared with those who were unable to resume employment following surgery.</p><p><strong>Results: </strong>This consecutive series included 515 patients (292 male, mean age 36.8 ± 9.2 years). Clinical presentation included 410 patients (79.6%) with epilepsy and 105 (20.4%) with incidental findings. Preoperatively, the mean Karnofsky Performance Scale (KPS) score was 95.7 ± 5.4 and mean tumor volume was 56.3 ± 45.4 cm3. Four patients (0.8%) experienced persistent postoperative neurological deficit. The mean postoperative KPS score was 94.4 ± 6.2, with persistent intractable epilepsy in 34 patients (6.6%). Moreover, 471 patients were able to RTW (91.5%). The mean extent of resection (EOR) was 91.8% ± 8.6%, with supratotal/total EOR in 164 patients (31.8%), and the mean residual tumor volume was 5.8 ± 8.1 cm3. The tumor type was IDH-mutant astrocytoma in 294 patients (57.1%) and oligodendroglioma in 221 (42.9%). Early adjuvant oncological treatment was administered in 80 patients (15.5%), and 161 patients (31.3%) underwent reoperation. The mean follow-up was 8.3 ± 4.3 years, with an overall survival (OS) rate of 79.5%. RTW was correlated with a higher KPS score before and after surgery (p < 0.0001), lower proportion of intractable seizures preoperatively (p = 0.027) and postoperatively (p = 0.001), smaller tumor volume before (p = 0.002) and after (p = 0.004) surgery, greater EOR (p = 0.0004), and absence of early adjuvant therapy (p = 0.013). Moreover, RTW was associated with a higher rate of reoperation (p = 0.026) and longer OS (p = 0.005).</p><p><strong>Conclusions: </strong>This is the first ever published consecutive cohort study demonstrating that RTW following awake mapping-guided resection of G2G was significantly correlated to better functional status, greater EOR, higher likelihood of further surgery, and prolonged OS, regardless of tumor location and molecular pattern. These findings support earlier and maximum resection, with the goal of preserving the capacity for employment because a more active lifestyle is associated with prolonged life expectancy.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1151-1160"},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421853","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 approaches and clinical challenges of imaging in peripheral nerve tumors: data from the multicenter Peripheral Nerve Tumor Registry.","authors":"Nadja Grübel, Bernd Schmitz, Anne-Kathrin Uerschels, Oliver Gembruch, Christoph Scholz, Felix Schöffing, Christine Brand, Thomas Kretschmer, Jakob Kraschl, Benjamin Mayer, Nora F Dengler, Stefanie Deininger, Gregor Antoniadis, Christian Rainer Wirtz, Andrej Pala, Maria Teresa Pedro, Marc Hohenhaus","doi":"10.3171/2026.1.JNS252409","DOIUrl":"10.3171/2026.1.JNS252409","url":null,"abstract":"<p><strong>Objective: </strong>Peripheral nerve tumors (PNTs) are diagnostically challenging due to their heterogeneous histology, variable size, diverse anatomical locations, and imprecise signs of malignancy. Imaging is crucial for detection, characterization, and surgical planning. This study systematically assessed imaging data to identify diagnostic patterns and their limitations across different techniques, as well as to generate a focused, standardized imaging recommendation.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 396 patients with histopathologically confirmed tumors associated with peripheral nerves from five centers participating in the prospective Peripheral Nerve Tumor Registry in Germany and Austria. Preoperative imaging data including MRI, high-resolution ultrasound (HRU), CT, and PET-CT were evaluated with a focus on tumor size, contrast enhancement (CE), T2 signal characteristics, cystic components, and patterns of tissue infiltration and correlated with clinical and histopathologic data. MRI protocols were assessed for consistency.</p><p><strong>Results: </strong>MRI was the primary modality in 94.7% of patients (n = 375), although protocols varied: 7% lacked contrast-enhanced sequences, 22% lacked T2-weighted sequences, and 95% lacked apparent diffusion coefficient maps. Tumors were classified as benign (group 1, n = 321 [81.1%]), malignant (group 2, n = 24 [6.1%]), or rare (group 3, n = 51 [12.9%]). Median tumor sizes were 28.0 (IQR 22.0, range 4-130) mm, 59.5 (IQR 53.0, range 22-96) mm, and 52.0 (IQR 64.0, range 7-190) mm for groups 1-3, respectively. Benign tumors were significantly smaller than malignant and rare tumors (each p < 0.001). CE was present in 97.5%, mainly showing an inhomogeneous pattern in malignant and rare tumors. An inhomogeneous T2 signal (n = 214) and cystic components (n = 99) were more frequent in malignant (79%) and rare (43%) tumors. Perilesional edema (n = 13) and tissue infiltration (n = 26) were found in 84.6% of malignant and rare tumors. Receiver operating characteristic (ROC) analysis identified a tumor size cutoff of 44.5 mm, indicating malignancy (area under the ROC curve = 0.83, sensitivity 78.8%, specificity 75.0%). FDG (18-fluorodeoxyglucose)-PET revealed overlapping maximum standardized uptake values (6.1-33.7) across all groups.</p><p><strong>Conclusions: </strong>MRI offers critical morphological detail, supports differentiation between tumor subtypes, and guides surgical planning. Therefore, it is the imaging of choice in PNTs, whereas PET-CT and HRU may help to close diagnostic gaps left by MRI. Establishing standardized imaging protocols is essential to improve diagnostic accuracy and support consistent, high-quality patient care.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"1230-1240"},"PeriodicalIF":3.8,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421841","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":"Surgical treatment of schwannomas around the tarsal tunnel: a case series of 40 patients and systematic review of the literature.","authors":"Godard C W de Ruiter, Kirsten M Hayford, Thomas F H Vissers, Robert J Spinner","doi":"10.3171/2026.1.JNS252605","DOIUrl":"10.3171/2026.1.JNS252605","url":null,"abstract":"<p><strong>Objective: </strong>Schwannomas in the tibial, plantar, or medial calcaneal nerves around the ankle can mimic symptoms of tarsal tunnel syndrome. Outcomes after resection of schwannomas from these nerves have mainly been reported in case reports. The objectives of this study were to investigate the presentation and results for resection of schwannomas around the tarsal tunnel in a large case series and systematically review the currently available literature.</p><p><strong>Methods: </strong>Data from 40 patients (27 sporadic and 13 schwannomatosis cases) treated at 2 centers were retrospectively analyzed for preoperative type and duration of symptoms, schwannoma size at presentation, and outcome after resection. The following different locations around the ankle were compared: proximal to the tarsal tunnel (PTT), at the tarsal tunnel (ATT), and distal to the tarsal tunnel (DTT). The severity of symptoms was categorized in increasing order for pain only on touch, during load-bearing activities, and symptoms also at rest. Surgical outcome was assessed based on pain relief and occurrence of complications. The systematic literature review was performed using a PubMed and Embase search.</p><p><strong>Results: </strong>All but 1 patient presented with pain, local at the ankle, or neuropathic pain during weight-bearing activities (13/40, 32.5%). More than half of the patients also experienced symptoms at rest (52.5%). In 14 cases, the schwannoma was located PTT, in 17 cases ATT, and in 9 cases DTT in the plantar nerves. There were no significant differences in size and symptom duration at presentation for the different locations. Tumor size did not correlate with symptom severity. Outcomes after resection were excellent, with complete pain relief in all but 1 patient (97.0%). Complications included wound infection (5%) and temporary decreased sensation on the heel (7.5%). A review of 44 previously reported cases also frequently showed complete pain relief after resection.</p><p><strong>Conclusions: </strong>The results of this study show that schwannomas around the tarsal tunnel often present with severe pain symptoms, even if the lesion is still relatively small. Resection frequently results in excellent pain relief. During surgery, it may not be necessary to open the entire length of the tarsal tunnel, thereby limiting the size of the incision, especially in schwannomas located proximally or distally to the tarsal tunnel.</p>","PeriodicalId":16505,"journal":{"name":"Journal of neurosurgery","volume":" ","pages":"810-822"},"PeriodicalIF":3.8,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382136","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}