Journal of neurosurgical anesthesiology最新文献

{"title":"Reconsidering the Timing of Surgery After Ischemic Stroke: Implications of Immortal Time Bias.","authors":"Pian Gong, Yang Liu, Yichun Zou","doi":"10.1097/ANA.0000000000001129","DOIUrl":"10.1097/ANA.0000000000001129","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":"371"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148205100","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":"Does Anticipatory Hemodynamic Management Require Prediction?","authors":"Yu-Ting Lin, Ming-Hui Hung","doi":"10.1097/ANA.0000000000001166","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001166","url":null,"abstract":"","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069673","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":"Dynamic Noninvasive Assessment of Intracranial Pressure, Cerebral Perfusion Pressure, and Autoregulation.","authors":"Ihsane Olakorede, Stefan Yu Bögli, Marek Czosnyka, Peter Smielewski","doi":"10.1097/ANA.0000000000001165","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001165","url":null,"abstract":"<p><strong>Background: </strong>Intracranial pressure (ICP) monitoring is critical for managing traumatic brain injury, yet invasive methods carry risks and require specialized settings. Noninvasive transcranial Doppler (TCD)-based methods have been proposed to estimate ICP and cerebral perfusion pressure (CPP), although validation studies predominantly assess static agreement. Clinical monitoring depends on accurate reproduction of dynamic changes. This study assesses the ability of noninvasive methods to reproduce temporal variations in ICP, CPP, and autoregulatory indices.</p><p><strong>Methods: </strong>Nonoverlapping 5-minute segments from 96 simultaneous ICP and TCD recordings in 38 TBI patients were analyzed. Eight blood velocity-based models were used to derive noninvasive estimates of ICP, CPP, pressure reactivity index (PRx), and mean flow index (Mx). Agreement was assessed using correlation and Bland-Altman analyses, whereas dynamic performance was evaluated using first-order differences and linear mixed-effects modeling. Discriminative ability for intracranial hypertension (ICP>22 mm Hg), low CPP (<60 mm Hg), and impaired autoregulation (PRx>0.3; Mx>0.4) was examined using receiver operating characteristic and precision-recall analyses.</p><p><strong>Results: </strong>Noninvasive estimates of CPP and Mx demonstrated stronger dynamic agreement with their reference measures than noninvasive estimates of ICP and PRx. Selected models showed robust discrimination of low CPP and impaired Mx (area under the curve up to 0.96 and 0.89). Conversely, reproduction of ICP dynamics and PRx was moderate, with significant interpatient and intrapatient variability. Dynamic analyses revealed discrepancies missed by static agreement metrics.</p><p><strong>Conclusions: </strong>Evaluation of noninvasive ICP monitoring should extend beyond static accuracy. TCD-based approaches may support noninvasive monitoring of CPP and Mx, but current methods remain insufficient for reliable tracking of ICP and PRx dynamics.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039303","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":"Factors Associated With 3-Month Neurological Outcome in Pediatric Patients With Traumatic Brain Injury: A Preliminary Study.","authors":"Indu Kapoor, Chandini Kukanti, Hemanshu Prabhakar, Charu Mahajan","doi":"10.1097/ANA.0000000000001164","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001164","url":null,"abstract":"<p><strong>Background: </strong>Traumatic brain injury (TBI) is associated with significant morbidity and mortality in pediatric patients. We aimed to evaluate demographic, clinical, and intensive care unit (ICU)-related factors associated with neurological outcome assessed using the Glasgow Outcome Scale-Extended (GOSE) in pediatric patients with moderate to severe TBI.</p><p><strong>Methods: </strong>Pediatric patients (18 y or younger) with moderate to severe TBI (Glasgow Coma Scale [GCS] ≤12) admitted in the neuro-ICU were enrolled (November 1, 2024, to November 30, 2025). The primary outcome was to evaluate the association of demographic, clinical, and ICU-related variables with functional outcome at 3 months. Multivariable logistic regression identified factors associated with neurological outcome; and P<0.05 was considered significant.</p><p><strong>Results: </strong>A total of 82 patients were included (median [range] age of 5 [2 to 9] y; male:female ratio: 58:24). At 3 months, 61 patients had GOSE ≥5 and 18 had GOSE ≤4 (lost to follow-up: 3 patients). Patients with a favorable outcome (GOSE ≥5) had significantly higher admission GCS and GCS-Pupil (GCS-P) score, favorable pupillary reactivity, lower rates of intubation, bradycardia, hypotension, hyperglycemia, hyperlactatemia, coagulopathy, inotrope use, tracheostomy, and early enteral feeding. On multivariable analysis, admission GCS (OR: 0.33, 95% CI: 0.15-0.74; P=0.007), systolic blood pressure <20% from baseline (OR: 0.046, 95% CI: 0.004-0.49; P=0.011), and tracheostomy (OR: 0.085, 95% CI: 0.009-0.79; P=0.031) were independently associated with a favorable outcome.</p><p><strong>Conclusion: </strong>Our preliminary data suggest that higher admission GCS, lower incidence of hypotension, and tracheostomy are associated with a favorable neurological outcome at 3 months in pediatric patients with moderate to severe TBI.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963444","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":"Opioid-Sparing Versus Opioid-Based Analgesia for Craniotomy: A Multicenter Randomized Controlled Trial.","authors":"Kamath Sriganesh, Georgene Singh, Prasanna U Bidkar, Manikandan Sethuraman, Srilata Moningi, Smita Vimala, Srinivasan Swaminathan, Keta Thakkar, Vinoda T Jissa, Venkataramaiah Sudhir, Padmaja Durga","doi":"10.1097/ANA.0000000000001163","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001163","url":null,"abstract":"<p><strong>Introduction: </strong>Pain control remains a challenge after neurosurgery. Opioid-sparing analgesia may provide better pain relief without opioid-related side effects after craniotomy. We aimed to compare analgesia requirement and postoperative pain between opioid-sparing and opioid-based analgesia for craniotomy.</p><p><strong>Methods: </strong>This investigator-initiated, multicenter randomized controlled trial was conducted at 5 Indian centers from October 19, 2022, to September 5, 2024, in adult patients undergoing elective craniotomy for brain tumors, following trial registration (CTRI/2022/09/045705, September 20, 2022). Patients received fentanyl 1 µg.kg-1.h-1 or dexmedetomidine 0.5 µg.kg-1.h-1 in a 1:1 allocation ratio after anesthetic induction until dural closure as the primary systemic analgesic. In addition, patients received intraoperative loco-regional analgesia. Our primary outcomes were intraoperative rescue opioid consumption and incidence of moderate-to-severe pain on the numerical rating scale (NRS) in the postanesthesia care unit (PACU). Secondary outcomes were pain on the first 2 postoperative days, drug-associated harms, recovery profile, patient satisfaction, quality of sleep, hospital stay duration, and persistent pain at 3 and 6 months.</p><p><strong>Results: </strong>There was no difference between fentanyl (n=252) and dexmedetomidine (n=248) groups for rescue fentanyl (38.0±63.1 vs. 44.6±81.7 μg, P=0.327) or moderate-to-severe pain in the PACU (145/242 vs. 138/233, P=0.559). Intraoperative hypotension was more common with dexmedetomidine (100/248 vs. 75/252, P=0.015), while shivering was lower than with fentanyl (9/241 vs. 22/251, P=0.026). Other outcomes were similar between groups.</p><p><strong>Conclusions: </strong>Both opioid-based and opioid-sparing regimens were similar regarding rescue analgesia, postoperative pain, and other in-hospital outcomes in patients undergoing craniotomy. Dexmedetomidine increased the occurrence of intraoperative hypotension and reduced postoperative shivering compared with fentanyl.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892025","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 Performance of Pulse Pressure Variation for Predicting Fluid Responsiveness During Spine Surgery in the Prone Position: A Systematic Review and Meta-Analysis.","authors":"Anshit Goyal, Kiran S Merchant, Eric Deloso, Selby G Chen, Kingsley Abode-Iyamah, Philip M Jones, Shaun E Gruenbaum, Benjamin F Gruenbaum","doi":"10.1097/ANA.0000000000001160","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001160","url":null,"abstract":"<p><strong>Background: </strong>Pulse pressure variation (PPV) is widely used to guide fluid responsiveness in mechanically ventilated patients, but its accuracy in the prone position remains uncertain. Prone positioning alters respiratory mechanics and venous return, potentially diminishing the respiratory variation in stroke volume that PPV is designed to detect. We conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of PPV for predicting fluid responsiveness during prone spine surgery.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, Scopus, and Cochrane through July 2025 for prospective studies evaluating PPV in adults undergoing prone spine surgery. Two reviewers independently screened studies, extracted data, assessed risk of bias using QUADAS-2, and pooled diagnostic performance using a bivariate random-effects model. The protocol was registered with PROSPERO (CRD420251106134).</p><p><strong>Results: </strong>Of 599 records, 34 underwent full-text review, and 10 studies (433 patients) were included. PPV thresholds ranged from 7% to 15%. Most studies were at low risk of bias except for the index test because thresholds were determined post hoc. For predicting fluid responsiveness, PPV had a pooled sensitivity of 68% (95% CI: 61%-75%) and specificity of 76% (95% CI: 65%-84%), with a summary area under the receiver operating characteristic curve of 0.72 (95% CI: 0.64-0.80).</p><p><strong>Conclusions: </strong>PPV showed only moderate diagnostic performance for predicting fluid responsiveness during prone spine surgery. Its performance may have been influenced by threshold variability, heterogeneous reference standards, fluid-challenge protocols, ventilation strategies, and positioning systems. PPV should therefore be interpreted alongside complementary dynamic assessments rather than in isolation, particularly during lung-protective ventilation.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892039","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":"Timing and Incidence of Airway Interventions Following Occipitocervical Fusion: A Retrospective Study Using the Nationwide Inpatient Sample 2017 to 2022.","authors":"Ammar Siddiqui, Aryan Malhotra, Gabriel Rodriguez, Jason Chui, Apolonia E Abramowicz","doi":"10.1097/ANA.0000000000001162","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001162","url":null,"abstract":"<p><strong>Background: </strong>Occipitocervical fusions (OCFs) are associated with adverse airway events. The period of airway compromise remains poorly defined. The objective of this study was to identify differences between OCF and posterior cervical fusion not involving the occipitocervical joint (NOCF) in the timing and incidence of postoperative airway interventions.</p><p><strong>Methods: </strong>Using the 2017 to 2022 Nationwide Inpatient Sample, we identified 1908 OCF and 38,743 NOCF hospitalizations (excluding anterior surgeries and spinal cord injury at or above C5). Survey‑weighted logistic regression and competing‑risks analysis were used to assess the incidence and temporal patterns of postoperative airway instrumentation.</p><p><strong>Results: </strong>OCF was associated with higher odds of tracheostomy (6.34% vs. 1.35%; adjusted OR=2.42; 95% CI: 1.92-3.05; P<0.001) and reintubation (2.10% vs. 0.78%; OR=1.54; 95% CI: 1.09-2.19; P=0.015) overall. On qualitative assessment of cumulative incidence curves, OCF demonstrated a distinct temporal crossover: tracheostomies exceeded reintubations by POD 3. Reintubation leveled off near the second postoperative week after OCF compared with the first week after NOCF, while tracheostomy placement leveled off around the third week after OCF compared with the second week after NOCF. The weighted 30-day cumulative incidence of tracheostomy was 5.31% for OCF versus 1.22% for NOCF (Gray P<0.001), and for reintubation it was 2.10% versus 0.77% (Gray P<0.001), with death and discharge as competing events.</p><p><strong>Conclusion: </strong>Following OCF, postoperative tracheostomies and reintubations occur more frequently and over a more prolonged postoperative period compared with NOCF. By POD 3, tracheostomies were performed more frequently than reintubations in OCF.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891953","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":"Preoperative Resting-State EEG Features Associated With Chronic Postoperative Pain After Breast Cancer Surgery: A Prospective Cohort Study.","authors":"Yaru Li, Yiqiyuan Zhang, Qi Han, Yujing Long, Shu Wang, Bailin Jiang, Yi Feng","doi":"10.1097/ANA.0000000000001161","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001161","url":null,"abstract":"<p><strong>Background: </strong>Chronic postoperative pain after breast cancer surgery varies substantially among patients and may reflect individual neurophysiological susceptibility. We explored whether preoperative resting-state electroencephalography (EEG) features are associated with clinically significant chronic postoperative pain.</p><p><strong>Methods: </strong>In this prospective cohort study, 100 female patients scheduled for mastectomy or breast-conserving surgery were enrolled. After exclusions for incomplete EEG acquisition, protocol changes, loss to follow-up, or poor EEG quality, 84 patients were analyzed. Preoperative variables included age, body mass index, American Society of Anesthesiologists physical status, neoadjuvant chemotherapy, surgical approach, and axillary lymph node dissection (ALND). At 3 months, patients were classified as higher-pain (HP; Numeric Rating Scale [NRS] ≥4) or lower-pain (LP; NRS <4). Exploratory analyses compared clinical characteristics, spectral power, and functional connectivity between groups.</p><p><strong>Results: </strong>Twenty-seven patients (32.1%) were classified as HP. The median [IQR] 3-month NRS score was 5 [4 to 6] in the HP group and 1 [0 to 2] in the LP group. Mastectomy versus breast-conserving surgery (OR=3.43, 95% CI: 1.31-8.99; P=0.010) and ALND versus no ALND (OR=5.75, 95% CI: 2.12-15.59; P<0.001) were associated with higher pain. Preoperative gamma-band power at F3, Fz, and F4 was higher in HP patients, with no group differences in other bands. Gamma-band connectivity involving frontal, insular, and cingulate regions was also stronger in the HP group.</p><p><strong>Conclusions: </strong>Preoperative frontal gamma activity and connectivity may reflect baseline neurophysiological vulnerability to chronic postoperative pain after breast cancer surgery. These exploratory group-level findings warrant validation in larger cohorts.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906477","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":"Feasibility of F-Waves Monitoring Under General Anesthesia With Remimazolam: A Prospective Observational Study.","authors":"Sachiko Kawasaki, Hironobu Hayashi, Tsunenori Takatani, Yusuke Yamamoto, Hideki Shigematsu, Keisuke Masuda, Takuya Sada, Yasuhiro Takeshima, Masahiko Kawaguchi, Kenji Kawamura","doi":"10.1097/ANA.0000000000001159","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001159","url":null,"abstract":"<p><strong>Background: </strong>F-waves are produced by the re-excitation of spinal anterior horn cells following distal electrical stimulation without being mediated through a conventional monosynaptic reflex pathway. F-waves can often be recorded even when voluntary motor output is limited and have been investigated as an adjunctive modality for intraoperative neurophysiological monitoring. However, some anesthetic agents affect intraoperative spinal neuromonitoring. Remimazolam is a novel, relatively safe anesthetic agent, especially for older adults, and its effects on F-waves are unclear. Therefore, we aimed to assess F-waves in patients undergoing spine and spinal cord surgery under remimazolam anesthesia.</p><p><strong>Methods: </strong>We prospectively evaluated 25 patients scheduled for prolonged spine or spinal cord surgery (≥3 h). F-waves were intraoperatively recorded from the left abductor hallucis at baseline and hourly thereafter. The persistence, normalized minimum latency, and amplitudes of the F-waves and F/M amplitude ratio were determined. In addition, their longitudinal changes under remimazolam anesthesia were assessed using linear mixed-effects models. Multivariable linear regression analysis was performed to identify factors associated with a change in F-wave persistence at 3 hours. Age, preoperative manual muscle test score, and baseline persistence were included as covariates.</p><p><strong>Results: </strong>None of the F-wave parameters showed significant time-dependent changes. The preoperative manual muscle test result was not an independent predictor of the change in F-wave persistence observed in the multivariable model.</p><p><strong>Conclusions: </strong>F-waves remained recordable without significant time-dependent changes in most patients under remimazolam anesthesia for up to 3 hours, suggesting that remimazolam has minimal effects on F-wave recordings.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887907","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":"Disruption of Sensorimotor Network Connectivity in Patients With Supratentorial Gliomas During Mild Sedation With Midazolam: An Exploratory Interventional Study.","authors":"Xueke Yin, Qihui Wang, Adrian W Gelb, Yuming Peng, Ruquan Han, Ding Ma, Min Zeng, Jia Dong, Xingyue Zhang, Tingting Ma, Xiuqin Jia, Nan Lin","doi":"10.1097/ANA.0000000000001157","DOIUrl":"https://doi.org/10.1097/ANA.0000000000001157","url":null,"abstract":"<p><strong>Introduction: </strong>Midazolam has been shown to induce transient motor deficits in patients with supratentorial gliomas. However, its effects on brain networks remain unclear, given the compensatory network reorganization in response to tumor-induced damage. This study examined sensorimotor network (SMN) intra- and internetwork functional connectivity before and after midazolam mild sedation in patients with motor cortex gliomas, compared with healthy controls.</p><p><strong>Methods: </strong>Glioma patients and healthy volunteers underwent resting-state functional MRI in the awake state and mild midazolam sedation. Regions of interest were defined in the primary motor cortex (M1) using a 6 mm radius. Statistical significance was set at an uncorrected voxel-wise threshold of P<0.001 and a false discovery rate-corrected cluster-wise threshold of P<0.05. This trial was registered at clinicaltrials.gov (NCT03984240) on June 11, 2019.</p><p><strong>Results: </strong>Thirty-four participants (18 glioma patients and 16 healthy volunteers) were analyzed. Glioma patients showed reduced negative functional connectivity between the SMN and the default mode network (DMN) in the awake state (P<0.05) and decreased SMN intranetwork connectivity. Following mild midazolam sedation, glioma patients demonstrated enhanced SMN intranetwork connectivity, with increased connectivity between M1 and the bilateral precentral gyrus, postcentral gyrus, and supramarginal regions (all P<0.001). Internetwork connectivity was decreased between M1 and the temporal fusiform cortex (T=8.05 and P=0.01), and between M1 and the occipital fusiform gyrus/inferior lateral occipital cortex (T=5.88 and P=0.002).</p><p><strong>Conclusion: </strong>Midazolam mild sedation alters SMN connectivity in glioma patients, characterized by enhanced intranetwork compensation and impaired cross-network integration. These findings suggest potential vulnerabilities of functional brain networks during the perioperative period.</p>","PeriodicalId":16550,"journal":{"name":"Journal of neurosurgical anesthesiology","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874269","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}