Journal of neurosurgical anesthesiology最新文献

{"title":"Beyond Recordable MEPs: Toward a More Reliable IONM Environment.","authors":"Jayanth R Seshan, Prasanna U Bidkar","doi":"10.1097/ANA.0000000000001176","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001176","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220143","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":"Perioperative Hyperlactatemia in Brain Tumor Craniotomy Is Not Always a Warning Sign.","authors":"Yu Chang, Hong-Min Lin","doi":"10.1097/ANA.0000000000001175","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001175","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220161","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":"In Response: Hormonal Status as an Uncontrolled Variable in the Assessment of Aprepitant Efficacy for PONV Following Acoustic Neuroma Surgery.","authors":"Martin Krause, Rodney A Gabriel, Brian P Lemkuil","doi":"10.1097/ANA.00000000000011551","DOIUrl":"https://doi.org/10.1097/ANA.00000000000011551","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194590","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":"Global Neurointensive Care: A Field Yet to Be Born.","authors":"Daniel A Godoy, Hemanshu Prabhakar, Andrés M Rubiano","doi":"10.1097/ANA.0000000000001173","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001173","url":null,"abstract":"<p><p>Neurological conditions represent the leading cause of disability-adjusted life-years (DALYs) and the second leading cause of death globally, with more than 11 million deaths annually, 87% of which occur in low- and middle-income countries (LMICs). While global neurosurgery has emerged as a recognized field with dedicated frameworks for advocacy and action, the critical care continuum of neurological disease has been persistently overlooked. Global neurointensive care (GNIC) does not yet exist as a formally defined discipline, yet its need is urgent and measurable: ICU bed density in LMICs ranges from 0.1 to 2.5 per 100,000 inhabitants compared with 5 to 30 per 100,000 in high-income countries (HICs); a cross-sectional survey of 408 providers from 42 LMICs found that only 36.8% had access to a dedicated neurointensive care unit; and traumatic brain injury (TBI) mortality at 6 months exceeds 37% in Latin American LMICs. This viewpoint defines GNIC, characterizes the epidemiological and structural dimensions of the unmet need with granular supporting evidence, reviews existing initiatives and their limitations, and proposes a 6-domain strategic agenda for its development. GNIC must be established as a field parallel and complementary to global neurosurgery, ensuring the critical care continuum of neurological disease is not abandoned in the global effort towards universal health coverage.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194629","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":"Immediate Perioperative Hypersensitivity and Anaphylaxis in Neuroanesthesia Practice: A Focused Review.","authors":"Mariel Manlapaz, Ehab Farag","doi":"10.1097/ANA.0000000000001174","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001174","url":null,"abstract":"<p><p>Perioperative hypersensitivity reactions are uncommon but potentially catastrophic. Neurosurgical and spine patients are especially vulnerable, as the injured brain and spinal cord tolerate anaphylaxis-induced hypotension poorly, cerebral and spinal perfusion may fall precipitously, and draping of the head and torso may obscure cutaneous signs. These procedures also rely heavily on topical hemostatic agents. National audits estimate the incidence of perioperative anaphylaxis at roughly 1 in 5000 to 10,000 anesthetics, but estimates vary geographically. No study has reported a denominator-based incidence confined to neurosurgery, leaving the true burden uncharacterized for this surgical specialty. This focused review summarizes the agents, mechanisms, and perioperative implications of immediate hypersensitivity and anaphylaxis relevant to neuroanesthesia. Immediate reactions are immunologic (IgE-mediated, or IgG- and complement-mediated) or nonimmunologic (direct mast-cell activation) but converge on mast-cell and basophil mediator release, which renders their presentations largely indistinguishable. We examine agents of relevance to neurosurgery, including neuromuscular blocking agents, cefazolin and other β-lactams, chlorhexidine, sugammadex, gelatin-based and other hemostatic agents, protamine, tranexamic acid, fluorescent and dye agents, and iodinated contrast media-alongside their mechanisms and safer alternatives. Management follows international consensus recommendations centered on prompt epinephrine administration and fluid resuscitation titrated to severity. Antihistamines and corticosteroids are useful adjuncts but should not delay resuscitation. Improved outcomes depend on greater awareness, careful allergy assessment and appropriate de-labeling, surgical-anesthesia communication, and wider access to testing and dedicated surveillance.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194595","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 Association Between Intraoperative Cell Salvage and Tumor Recurrence in Patients Undergoing Meningioma Resection: An Observational Study.","authors":"Xiaonan Liu, Yue Ren, Shu Li, Yuming Peng","doi":"10.1097/ANA.0000000000001170","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001170","url":null,"abstract":"<p><strong>Background: </strong>The oncologic safety of intraoperative cell salvage (ICS) during meningioma surgery remains controversial due to concerns about hematogenous tumor dissemination. We investigated the association between ICS use and postoperative tumor recurrence in patients undergoing meningioma resection.</p><p><strong>Methods: </strong>This study retrospectively included adult patients who underwent meningioma resection with intraoperative blood loss >1000 mL at Beijing Tiantan Hospital between August 2015 and November 2022. The primary outcome was postoperative tumor recurrence. Propensity scores were estimated using clinically relevant baseline variables, and inverse probability of treatment weighting with stabilized weights was applied to reduce confounding.</p><p><strong>Results: </strong>Among 988 patients, 89 (9.0%) developed recurrence during a mean follow-up of 60 months. Recurrence was less frequent in patients receiving ICS than in those without ICS (7.9% vs. 14.9%, P=0.004). After inverse probability of treatment weighting adjustment, baseline characteristics were well balanced between groups. In the weighted Cox model, ICS use was not associated with increased recurrence risk (HR=0.62, 95% CI: 0.39-0.99, P=0.043). Higher WHO grade was independently associated with increased recurrence risk, whereas gross total resection was associated with reduced risk. Sensitivity analyses yielded consistent results.</p><p><strong>Conclusion: </strong>In patients undergoing meningioma surgery with substantial intraoperative blood loss, intraoperative cell salvage was not associated with an increased risk of tumor recurrence.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Perioperative Hematocrit With Postoperative Neurological Complications in Adults Undergoing Revascularization Surgery for Moyamoya Disease: A Retrospective Cohort Study.","authors":"Ji H Sim, Hyeong S Yoon, Namho Kim, Young K Kim, Joung U Kim","doi":"10.1097/ANA.0000000000001171","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001171","url":null,"abstract":"<p><strong>Objective: </strong>Hematocrit influences blood viscosity and cerebral oxygen delivery, but its perioperative significance in adults with moyamoya disease (MMD) remains unclear. This study evaluated the associations of preoperative hematocrit, postoperative hematocrit, and delta hematocrit, defined as preoperative minus postoperative hematocrit, with postoperative neurological complications following revascularization surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 220 adults who underwent revascularization for MMD at a tertiary center in South Korea between 2012 and 2020. The primary analysis assessed the association between preoperative hematocrit and postoperative neurological complications. Secondary analyses examined postoperative hematocrit and delta hematocrit. Multivariable associations were estimated using Firth penalized logistic regression. Restricted cubic spline analyses were performed to assess potential nonlinear associations.</p><p><strong>Results: </strong>Postoperative neurological complications occurred in 47 patients (21.4%). Higher preoperative hematocrit (odds ratio [OR]=1.17, 95% CI: 1.04-1.33; P=0.008) and postoperative hematocrit (OR=1.15, 95% CI: 1.04-1.29; P=0.005) were associated with complications after multivariable adjustment. Delta hematocrit was not associated with complications in linear analysis (OR=0.91, 95% CI: 0.80-1.01; P=0.081). An exploratory restricted cubic spline analysis did not identify a significant association between delta hematocrit and postoperative neurological complications (overall P=0.060).</p><p><strong>Conclusions: </strong>Higher preoperative and postoperative hematocrit levels were associated with postoperative neurological complications after multivariable adjustment; however, because the timing of the postoperative measurement relative to the onset of complications was uncertain, postoperative hematocrit should not be interpreted as a predictive variable. Perioperative change in hematocrit showed a more complex exploratory pattern after accounting for baseline hematocrit, but this finding requires confirmation in larger cohorts.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194662","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":"Pressure Points: A Scoping Review of Intracranial Pressure and Mean Arterial Pressure Measurement and Reporting Practices in Neurocritical Care.","authors":"Marisol Eltit, Alejandra González, Andres Giglio, Monserrat Pino, Andres Ferre, Andrés Reccius","doi":"10.1097/ANA.0000000000001172","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001172","url":null,"abstract":"<p><p>Cerebral perfusion pressure (CPP) is a cornerstone of neurocritical care, but the literature shows substantial heterogeneity in how its components-intracranial pressure (ICP) and mean arterial pressure (MAP)-are reported. We conducted a scoping review following the Joanna Briggs Institute methodology and PRISMA-ScR to map this variability. Structured searches in PubMed and Scopus (January 1997 to May 2026) identified 350 eligible original clinical studies. For each study, we extracted whether the ICP measurement method, ICP device, ICP zero reference, MAP measurement method, and arterial line zero reference were reported. Reporting completeness was analyzed overall and stratified by guideline era and primary diagnosis, using the χ2 tests, odds ratios with 95% CI, and the Cochran-Armitage test for trend. The ICP measurement method was reported in 84.0% of studies, and the ICP zero reference in 14.6%; the MAP method in 66.9%, and the arterial line zero reference in 28.6%. Only 6.6% of studies reported all 5 domains. After publication of the Brain Trauma Foundation fourth Edition, reporting improved across most domains-ICP method (79.0% vs. 96.1%, P<0.001) and arterial line zero reference (20.2% vs. 49.0%, P<0.001)-and the composite reporting score rose from 2.37 to 3.06 (P<0.001). ICP zero-reference reporting was similar between eras (16.5% vs. 9.8%, P=0.105) while showing a significant declining trend across the study period (Cochran-Armitage Z=-2.52, P=0.012). Traumatic brain injury and hemorrhagic conditions had the lowest ICP zero reference reporting (8.8% and 9.3%; OR=0.35 for TBI vs. non-TBI, 95% CI: 0.19-0.65). Improvements in reporting have not reached the level needed to determine whether CPP values are comparable across studies. We propose an 11-item Minimum Reporting Set for CPP-related studies.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Intraoperative Trigeminal Cardiac Reflex With Postoperative Myocardial Injury in Patients Undergoing Skull Base Tumor Surgery: A Prospective Cohort Study.","authors":"Hongxun Mei, Maoyao Zheng, Min Zeng, Juan Wang, Shu Li, Jie Wang, Qianyu Cui, Xiudong Guan, Deling Li, Yuming Peng","doi":"10.1097/ANA.0000000000001167","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001167","url":null,"abstract":"<p><strong>Background: </strong>The association between intraoperative trigemino-cardiac reflex (TCR) and postoperative myocardial injury in patients undergoing skull base tumor resection remains unclear.</p><p><strong>Methods: </strong>This single-center prospective observational study enrolled patients undergoing elective skull base tumor resection between April 2023 and September 2024. The primary outcome was postoperative myocardial injury, defined as a cardiac troponin I level >16 ng/L within 24 hours after surgery. Patients were categorized into TCR and non-TCR groups. Logistic regression analyses were performed to explore factors associated with intraoperative TCR and postoperative myocardial injury.</p><p><strong>Results: </strong>Among 476 included patients, intraoperative TCR occurred in 27.9%, and postoperative myocardial injury occurred in 4.83%. Patients experiencing TCR had a higher rate of myocardial injury (8.3% vs. 3.5%, P=0.029). Multivariable analysis suggested that brainstem compression (adjusted OR=1.86; 95% CI: 1.19-2.91; P=0.007) and larger tumor diameter (adjusted OR=1.04; 95% CI: 1.02-1.07; P<0.001) independently associated with intraoperative TCR. TCR (adjusted OR=2.70; 95% CI: 1.12-6.53; P=0.028), older age (adjusted OR=1.06; 95% CI: 1.02-1.10; P=0.003), lower BMI (adjusted OR=0.80; 95% CI: 0.70-0.93; P=0.003), and tumor recurrence (adjusted OR=4.07; 95% CI: 1.43-11.57; P=0.009) were associated with postoperative myocardial injury after adjusting for selected confounders.</p><p><strong>Conclusion: </strong>Postoperative myocardial injury occurred in 4.83% of skull base tumor surgery patients. Intraoperative TCR increased the risk of this injury, though the link may relate to surgical complexity and patient characteristics. TCR may therefore serve as a potential clinical marker of patients at elevated perioperative cardiovascular risk rather than a direct causal mechanism.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182615","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":"Perioperative Considerations for an Infant With Kleeblattschädel Deformity: A Case Report.","authors":"Shalini M Bala, Sangeetha R Palaniswamy, Gugamsetti Sai Phaneendra, Subhas K Konar","doi":"10.1097/ANA.0000000000001168","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001168","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149110533","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}