Neurosurgical Review最新文献

{"title":"Clinical outcomes before and after the introduction of clazosentan in aneurysmal subarachnoid hemorrhage: a multicenter retrospective study of clipping and endovascular treatment.","authors":"Issei Takeuchi, Shinsuke Muraoka, Fumie Kinoshita, Takashi Izumi, Kazuki Ishii, Masahiro Nishihori, Shunsaku Goto, Ryuta Saito","doi":"10.1007/s10143-026-04469-6","DOIUrl":"https://doi.org/10.1007/s10143-026-04469-6","url":null,"abstract":"<p><strong>Objective: </strong>Definitive treatment for aneurysmal subarachnoid hemorrhage (aSAH) includes microsurgical clipping and endovascular treatment (EVT). In randomized trials such as ISAT and BRAT, EVT showed superiority in short-term outcomes and comparable or favorable long-term results. Delayed cerebral ischemia is one of the most important determinants of clinical outcomes after treatment for aneurysmal subarachnoid hemorrhage caused by ruptured intracranial aneurysms. Although its pathophysiology is multifactorial, cerebral vasospasm has long been considered a major contributing factor. In Japan, fasudil has traditionally been used as a perioperative pharmacological agent for the prevention of cerebral vasospasm; since 2022, clazosentan has also become available. This study aimed to compare outcomes between clipping and EVT before and after the introduction of clazosentan in patients with aSAH.</p><p><strong>Methods: </strong>Using RECOVER registry data, we analyzed patients with aSAH who underwent definitive treatment with clipping or EVT within 48 h of onset and received either fasudil or clazosentan between 2021 and 2024. The primary endpoint was a favorable functional outcome at discharge, defined as a modified Rankin Scale (mRS) score of 0-2. Secondary endpoints included cerebral vasospasm, delayed cerebral ischemia (DCI), pulmonary complications, hypotension, cerebral edema, and new intracranial hemorrhage. In multivariable analyses, we adjusted for age, World Federation of Neurosurgical Societies (WFNS) grade, Fisher group, anterior circulation aneurysm, and the use of cerebrospinal fluid drainage. The study period was divided into the fasudil era and the clazosentan era, corresponding to the periods before and after the introduction of clazosentan, respectively.</p><p><strong>Results: </strong>A total of 496 patients were analyzed, of whom 57.5% underwent microsurgical clipping. Overall, favorable outcomes at discharge, defined as an mRS score of 0-2, were significantly more frequent in the EVT group than in the clipping group (59.2% vs 48.4%, p = 0.004). In the fasudil era, the EVT group showed a higher proportion of favorable outcomes than the clipping group (59.0% vs 41.5%, p = 0.007), whereas no statistically significant between-group difference was observed in the clazosentan era (72.6% vs 62.7%, p = 0.15). Among secondary outcomes, the incidence of vasospasm-related DCI was not significantly different between the groups, although it was numerically lower in the EVT group.</p><p><strong>Conclusion: </strong>Functional outcomes appeared more favorable in both the clipping and EVT groups during the clazosentan era. Across all study periods, the observed proportion of patients with favorable functional outcomes was higher in the EVT group than in the clipping group. However, because formal interaction testing did not identify statistically significant effect modification, the apparent reduction in between-group difference","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Penetrating dural venous sinus injury: a scoping review of clinical presentation, operative management, and prognosis.","authors":"Yaxel Levin-Carrion, Jayant Bhasin, Taylor Campbell, Ebrahim Faizullabhoy, Kevin Titkov, Carlos Coronado-Guzman, Arman Sawnhey, Sraavya Anne, Daniela A Perez-Chadid, Drew Thibault, Alejandro Pando, Nemanja Novakovic, Hai Sun","doi":"10.1007/s10143-026-04451-2","DOIUrl":"10.1007/s10143-026-04451-2","url":null,"abstract":"<p><p>Penetrating injury to the dural venous sinuses (DVS) commonly occurs at the superior sagittal sinus (SSS), transverse sinus (TS), and torcular confluence. While rare, DVS penetrating injuries carry high risk of intracranial hemorrhage, air embolism, and venous infarction. The current literature pertaining to penetrating DVS injury consists primarily of isolated case reports and small series. This scoping review consolidates published cases to characterize mechanisms, management strategies, and clinical outcomes pertaining to penetrating DVS injury. A scoping literature search of PubMed, PubMed Central, Embase, and Scopus was performed through September 2025. English-language case reports, case series, and retrospective studies describing penetrating cranial trauma involving the SSS, TS, or torcula were included. Data were summarized descriptively. Twenty-five studies met inclusion criteria, encompassing low-velocity penetrating injuries, civilian firearm trauma, captive-bolt injuries, and wartime shrapnel. Low-velocity injuries were typically managed with wide exposure, circumferential sinus control, and either flow-preserving repair or selective SSS ligation, with favorable neurological outcomes. Firearm-related injuries demonstrated greater variability, ranging from excellent recovery after torcular reconstruction to delayed sinus thrombosis and fatal pulmonary air embolism following incomplete SSS sealing. Reconstruction was generally favored for posterior SSS, torcular, and dominant TS injuries, whereas ligation was better tolerated for anterior or mid-SSS lesions. Penetrating DVS injuries require early venous imaging, meticulous sinus control, and segment-specific decisions regarding repair versus ligation. Flow-preserving reconstruction is increasingly feasible and may optimize survival and neurological recovery.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative risk of instrumentation failure in dynamic and rigid spinal stabilization: a propensity-matched cohort study.","authors":"Idris Gurpinar, Furkan Almas, Nazenin Durmus, Ege Anil Ucar, Mehmet Yigit Akgun, Tunc Oktenoglu, Ozkan Ates, Ali Fahir Ozer","doi":"10.1007/s10143-026-04468-7","DOIUrl":"https://doi.org/10.1007/s10143-026-04468-7","url":null,"abstract":"<p><p>This study aims to compare the risk of instrumentation failure between dynamic and rigid posterior spinal stabilization systems using propensity score matched cohorts, and to investigate the role of spinopelvic parameters and patient-related factors in construct longevity. A retrospective analysis was conducted on 952 patients who underwent thoracic, thoracolumbar, thoracolumbosacral, lumbar, or lumbosacral instrumentation between 2018 and 2024. Instrumentation failure (rod fracture, screw fracture, migration, pull-out, or loosening) was identified in a subgroup of 106 patients. Propensity score matching (1:1 nearest-neighbor, caliper 0.1) was applied using age, sex, osteoporosis, number of instrumented segments, and involvement of S1 as the lowest instrumented vertebra, yielding two matched cohorts of 196 dynamic and 196 rigid stabilized cases with improved baseline comparability. Survival differences were assessed by Kaplan-Meier and log-rank tests, and multivariable Cox regression was performed in both the full cohort and matched groups to identify potential risk factors. The overall failure rate was 11.1%, with a significantly higher rate in rigid constructs than in PEEK rod/dynamic screw constructs (22.0% vs. 6.7%, p < 0.001). In the matched cohort, failure remained more frequent in the rigid group than in the dynamic group (24.5% vs. 10.7%, p < 0.001). Kaplan-Meier analysis demonstrated lower mechanical failure-free survival in rigid constructs (log-rank p < 0.001). In the matched Cox regression analysis, rigid stabilization (HR = 2.83, 95% CI 1.41-5.68), osteoporosis (HR = 4.40, 95% CI 2.08-9.27), PI-LL mismatch (HR = 1.03 per degree, 95% CI 1.01-1.06), and the age-number of instrumented segments composite variable (HR = 1.27, 95% CI 1.04-1.54) were associated with increased hazard of mechanical failure. In this large retrospective propensity-matched cohort with long-term follow-up, dynamic stabilization systems were associated with a significantly lower and delayed risk of instrumentation failure compared with rigid constructs. Restoration of sagittal alignment and consideration of patient-specific factors, including bone quality and spinopelvic morphology, appear important in reducing hardware-related complications. However, because of the observational design, residual confounding, and remaining imbalance after matching, these findings should be interpreted as associative and do not establish definitive superiority of one construct over another.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Predictors of recurrence and reintervention in non-acute subdural hematoma: A multimodal analysis of radiological, clinical, surgical, and endovascular factors.","authors":"C Alejandro Luzardo-Neira, José Rodrigo Muñoz-Ordoñez, Camilo Alvarado-Bedoya, Brunno Lara-Coba, Oscar Eduardo García-Ledesma, Valentina Mejía-Quiñones, Juan Andrés Mejía, Laura Olarte, Ana María Rendón, Carlos Roa, Laura Campaña-Perilla, Micxael Florez, Yeisson Esteban Montoya, Mauricio Acosta, Sergio Serrano-Gomez, Andrés Vasquez, Andrés Felipe Ortiz-Giraldo, Carlos Andrés Ferreira-Prada, Oliverio Vargas, Daniel Mantilla","doi":"10.1007/s10143-026-04471-y","DOIUrl":"https://doi.org/10.1007/s10143-026-04471-y","url":null,"abstract":"","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting psychiatric drug initiation after craniectomy: a retrospective cohort study.","authors":"Natalie Simon, Namita Gurung, Nathan Rockley, Katherine Burnett, Rose Ingleton, Soniya Chauhan, Sajjad Saghebdoust, S M Saiful Bari, Ahmed Abd Elmohseen, Abdel Rahman Osman, Pouya Behnam, Aimun A B Jamjoom","doi":"10.1007/s10143-026-04449-w","DOIUrl":"10.1007/s10143-026-04449-w","url":null,"abstract":"<p><p>Psychiatric morbidity following craniectomy remains underexplored, with physical disability outcome measures forming the mainstay of follow-up tests used during rehabilitation. There are no predictive models to identify patients at a higher risk of new psychiatric drug initiation. We investigated new psychiatric drug initiation in a mixed-indication cohort following craniectomy and developed a risk stratification model. Our retrospective single-centre study identified 145 patients who underwent a supratentorial craniectomy between 2020 and 2025. Predictor variables were selected based on clinical plausibility, including age, Glasgow Coma Scale (GCS), pupillary response, American Society of Anaesthesiologists (ASA) grade, Index of Multiple Deprivation (IMD) rank, indication for surgery, laterality, and comorbidities. The primary outcome was new psychiatric medication initiation in patients without a pre-existing psychiatric diagnosis. Logistic regression and LASSO penalised modelling were performed. The model was internally validated using bootstrap optimism correction and regression coefficient shrinkage. Across the whole cohort, 33.8% of patients were prescribed psychiatric medication. Of those without a pre-existing psychiatric diagnosis, 18.6% of patients were commenced on new psychiatric medication. Whilst no independent predictors were significant in multivariate analyses, LASSO regression retained higher GCS (coefficient + 0.0585), fewer comorbidities (coefficient - 0.1749), increasing age (coefficient + 0.0109), and a lower ASA (coefficient - 0.0838) as non-zero coefficients under penalisation. Our final model offered limited discrimination (apparent AUC 0.645; Brier score 0.144) with bootstrap internal validation revealing a mean optimism of 0.065 and an optimism-corrected AUC of 0.580 (optimism-corrected Brier score 0.156). We present the first internally validated risk prediction model for new psychiatric drug initiation in a mixed indication craniectomy cohort. Model discrimination was limited, indicating that baseline clinical variables are insufficient to identify patients at increased risk. Prospective studies incorporating gold-standard neuropsychiatric testing are needed before risk stratification could facilitate earlier neuropsychiatric referrals and support more holistic rehabilitation care.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13538168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal intramedullary melanocytoma: systematic review & clinical management considerations.","authors":"Linda Bättig, Alexis Paul Romain Terrapon, Felix C Stengel, Malte Mohme, Detlef Brügge, Natalia Vélez Char, Martin N Stienen, Lorenzo Bertulli","doi":"10.1007/s10143-026-04473-w","DOIUrl":"https://doi.org/10.1007/s10143-026-04473-w","url":null,"abstract":"<p><p>Spinal intramedullary melanocytoma (SIM) is an exceptionally rare benign melanocytic tumor of the central nervous system, with only a limited number of cases reported to date. Diagnosis is frequently delayed and relies on histopathological confirmation to differentiate SIM from other melanocytic lesions, including malignant melanoma. Owing to the rarity of this entity, its natural history, optimal management, and follow-up strategies remain insufficiently defined. We aimed to systematically synthesize the available evidence on clinical presentation, treatment strategies, and outcomes of SIM. A systematic review was conducted according to PRISMA guidelines. PubMed and Cochrane Library were searched up to April 15th, 2026 for reports of histologically confirmed SIM. Case reports and case series in English, French, and Spanish were included. Extracted data comprised demographics, tumor location, clinical presentation, treatment, extent of resection (EOR), adjuvant therapy, and outcomes. Descriptive statistics with 95% confidence intervals were calculated. An institutional illustrative case with 3-year follow-up is presented to complement the literature. Twenty-six publications comprising 35 patients were included. Mean age was 47 years and 40.0% were male. SIM most commonly involved the lower thoracic cord (68.8%). Sensory deficits (74.3%) and motor weakness (68.6%) were the predominant presenting symptoms. At long-term follow-up, neurological status was stable or improved in 84.0% of cases. Overall mortality was 17.1%; only 5.7% of deaths were directly attributable to local tumour progression. Recurrence occurred in 43.3% (13/30) during a mean follow-up of 28.1 months. Across resection groups, recurrence and long-term neurological outcome followed a graded pattern with extent of resection, but the trend test did not reach significance for recurrence (Cochran-Armitage trend test, p = 0.053) and was only of borderline significance for long-term outcome (p = 0.040); given the small, sparse subgroups these findings are hypothesis-generating. Although histologically benign, SIM carries a relevant risk of recurrence and neurological morbidity. Available evidence supports maximal safe resection as the primary treatment goal. Adjuvant radiotherapy may be considered after incomplete resection. Given the potential for delayed recurrence, structured and long-term MRI surveillance appears warranted.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148881266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pressure-controlled active CSF irrigation versus non-pressure-controlled management following aneurysmal subarachnoid hemorrhage: a systematic review and comparative meta-analysis of DCI and safety outcomes.","authors":"Ramtin Pourahmad, Mehrad Zare, Pouria Delbari, Kimia Rasouli, Mohammad Mehdi Hajiabadi","doi":"10.1007/s10143-026-04463-y","DOIUrl":"https://doi.org/10.1007/s10143-026-04463-y","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Delayed cerebral infarction (DCI) is a major cause of poor outcome after aneurysmal subarachnoid hemorrhage (aSAH) and is closely associated with intracranial blood burden. Pressure-controlled cerebrospinal fluid (CSF) irrigation techniques have been developed to actively accelerate blood clearance; however, their overall clinical effectiveness and safety profile have not been comprehensively evaluated in a comparative framework. Accordingly, we performed a systematic synthesis of the available evidence focusing on both clinical efficacy and treatment-related safety outcomes. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines to evaluate both safety and efficacy. PubMed/MEDLINE, Embase, and Scopus were searched from inception through October 15, 2025. Studies comparing pressure-controlled active CSF irrigation techniques (including stereotactic ventriculocisternostomy, cisterno-ventricular catheter systems, ventriculo-lumbar irrigation, and lumbo-lumbar irrigation) with non-pressure-controlled management were included. The primary radiographic outcome was delayed cerebral infarction. Secondary outcomes captured both additional efficacy endpoints and safety, including symptomatic vasospasm, in-hospital mortality, functional outcome, and procedure-related complications. Arm-specific outcome prevalences were pooled descriptively using random-effects models, while comparative treatment effects were synthesized as odds ratios from direct within-study comparisons between pressure-controlled and non-pressure-controlled management. Risk of bias was assessed using ROBINS-I and RoB 2. Nine studies comprising 2,033 patients were included; most evidence was observational and at serious risk of confounding. In direct within-study comparative meta-analyses, pressure-controlled irrigation was associated with lower odds of delayed cerebral infarction (OR 0.36, 95% CI 0.25-0.50), symptomatic vasospasm (OR 0.48, 95% CI 0.27-0.88), and imaging-defined vasospasm (OR 0.33, 95% CI 0.23-0.48). No statistically significant associations were observed for angiographic vasospasm (OR 0.59, 95% CI 0.30-1.17), in-hospital mortality (OR 1.19, 95% CI 0.83-1.69), shunt-dependent hydrocephalus (OR 1.03, 95% CI 0.48-2.22), or infectious complications (OR 0.75, 95% CI 0.46-1.21). Catheter-related hemorrhage was rare in descriptive intervention-group data, but adequate comparative analysis was unavailable. Comparative functional outcome analysis was not feasible because mRS data were insufficiently reported in non-pressure-controlled comparator arms. Direct comparative analyses showed no observed heterogeneity (I² = 0%), whereas descriptive prevalence estimates were substantially heterogeneous. Pressure-controlled active CSF irrigation was associated with lower odds of delayed cerebral infarction and symptomatic and imaging-defined vasospasm after aSAH. Effects on angiographic vasospasm, mortality, safety outcomes, and functional recovery","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of stereotactic radiosurgery for prostate cancer spine metastasis - impact on hormone sensitivity and treatment outcomes: a systematic review of literature.","authors":"Aaditya Dravid, Suvan Sundaresh, David Wang, Philip Heesen, Vivek Sanker, Amirhossein Akhavan-Sigari, Maria Jose Cavagnaro, Harminder Singh, John Ratliff, Atman Desai","doi":"10.1007/s10143-026-04464-x","DOIUrl":"https://doi.org/10.1007/s10143-026-04464-x","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Spinal metastases are a common and morbid manifestation of advanced prostate cancer. Stereotactic body radiotherapy (SBRT), including single-fraction stereotactic radiosurgery (SRS), has emerged as a high-precision modality capable of delivering ablative doses with excellent local control. However, outcomes following spinal SBRT may differ according to hormonal sensitivity, particularly between hormone-sensitive prostate cancer (HSPC) and castration-resistant prostate cancer (CRPC). To systematically evaluate outcomes following stereotactic body radiotherapy for prostate cancer spinal metastases and assess differences between hormone-sensitive and castration-resistant disease. A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, Web of Science, Cochrane Library, and Embase databases were searched on 20/06/2025. Eligible studies included adult patients with spinal metastases from prostate adenocarcinoma treated with SBRT/SRS and reported outcomes stratified by hormonal status where available. Data extracted included local control (LC), overall survival (OS), progression to castration resistance, pain response, treatment-related toxicity, and radiation dose-fractionation parameters including biologically effective dose (BED₃). Study quality was assessed using the ROBINS-I tool. Five studies including 322 patients and 501 spinal lesions were included. Spinal SBRT achieved high local control, with 1-2-year LC typically exceeding 90%. In the two studies (approximately 174 patients) that directly compared disease states, local control and survival were numerically and statistically more favourable in HSPC patients. Because this contrast rests on only two non-randomised studies with differing systemic-therapy exposure, it should be regarded as hypothesis-generating.Overall survival similarly favored HSPC, with 1- to 3-year OS rates markedly higher than those observed in CRPC populations. Progression to castration resistance was described in a minority of the studies but suggested more favorable disease control in HSPC patients, who also achieved deeper post-treatment PSA nadirs and lower rates of biochemical relapse. Pain response was favorable overall, with approximately half of symptomatic patients experiencing complete or partial pain relief. Treatment-related toxicity was low overall, with vertebral compression fracture rates ranging from 4-10% and predominantly grade I-II adverse events. Dose-fractionation schedules varied widely, with BED₃ values ranging from approximately 70 to 191 Gy₃; higher BED₃ regimens were commonly associated with durable local control, though optimal dosing thresholds remain undefined. These calculations are presented to illustrate radiobiological heterogeneity across treatment regimens, but they do not permit conclusions regarding dose-response relationships or optimal biological dose thresholds. Available data suggest that SBRT provides effective local control and meaningful sympt","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting 'idiopathic' spinal cord herniation: Evidence for an acquired pathogenesis from spinal anterior dural dissection.","authors":"Guillaume Dannhoff, Charles-Henry Mallereau, Tuong Lu, Aymen Ben Ali, Clovis Adam, Fabrice Parker, Nozar Aghakhani, Steven Knafo","doi":"10.1007/s10143-026-04466-9","DOIUrl":"https://doi.org/10.1007/s10143-026-04466-9","url":null,"abstract":"<p><strong>Purpose: </strong>Idiopathic spinal cord herniation (iSCH) is a rare cause of myelopathy characterized by protrusion of the spinal cord through a focal defect in the dura mater. Its pathogenesis remains poorly understood. In this study, we present evidence supporting an acquired mechanism involving dural dissection.</p><p><strong>Methods: </strong>We conducted a single-center case series of patients diagnosed with iSCH, with a focus on clinical and radiological features that provide insight into the condition's etiology and natural history.</p><p><strong>Results: </strong>We identified 18 patients with iSCH, including 15 who underwent surgical treatment. In 14 patients (78%), the initial magnetic resonance imaging (MRI) demonstrated a longitudinal cerebrospinal fluid (CSF) collection along the anterior aspect of the dural sac, consistent with spinal anterior dural dissection. Six patients initially presented with clinical features of spontaneous intracranial hypotension. In three of these cases, serial MRI demonstrated progressive herniation of the spinal cord through the dural defect over time. A histological analysis of the dystrophic herniated tissue in one patient retrieved fatty and gliotic degeneration, further supporting an acquired mechanism.</p><p><strong>Conclusion: </strong>Our findings support the hypothesis that iSCH might represent an acquired complication of spinal anterior dural dissection rather than a congenital abnormality of the spinal cord or dura. Accordingly, we propose reclassifying iSCH within the spectrum of duropathies, with spontaneous intracranial hypotension as a potential initial manifestation.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic endonasal transcavernous surgery for knosp grade 3-4 growth hormone-secreting pituitary neuroendocrine tumors: surgical outcomes and predictors of biochemical remission.","authors":"Ling Tian, Min Liu, Mei Luo, Cheng Zhou, Jian Gu, Jiajun Zeng, Qin Shen, Zhongyi Tong, Yi Jiang, Bihua Luo, Jian Lin, Zhifeng Sheng, Yong Peng","doi":"10.1007/s10143-026-04467-8","DOIUrl":"https://doi.org/10.1007/s10143-026-04467-8","url":null,"abstract":"<p><p>Achieving biochemical remission in growth hormone-secreting pituitary neuroendocrine tumors (GH-PitNETs) with cavernous sinus invasion (Knosp grade 3-4) remains a significant surgical challenge. The objective was to evaluate the outcomes of the endoscopic endonasal transcavernous approach (transcavernous-EEA) and identify predictors of postoperative biochemical remission. This retrospective study included 50 patients with Knosp grade 3-4 GH-PitNETs. Patients were divided into two cohorts: Group 1 (prior to October 2020) received conventional EEA, while Group 2 (after October 2020) underwent transcavernous-EEA. The biochemical remission rate was significantly higher in Group 2 (64.7%) than in Group 1 (31.3%) (P = 0.027), with comparable surgery-related morbidity. In Group 2, preoperative IGF-1 (OR 0.984, 95% CI 0.969-0.999) and postoperative day 1 (POD1) GH levels (OR 0.241, 95% CI 0.076-0.760) were independently associated with biochemical remission in an exploratory multivariable analysis. Receiver operating characteristic curve analysis determined preliminary cutoff values of 587 ng/ml for preoperative IGF-1 (AUC 0.739, P = 0.007; Specificity 58.3%) and 2.185 ng/ml for POD1 GH (AUC 0.898, P < 0.001; Specificity 83.3%). Transcavernous-EEA was associated with higher biochemical remission during short-term follow-up in Knosp grade 3-4 GH-PitNETs without increasing surgical morbidity. Preoperative IGF-1 and POD1 GH levels may help stratify the likelihood of postoperative remission following this approach.</p>","PeriodicalId":19184,"journal":{"name":"Neurosurgical Review","volume":"49 1","pages":""},"PeriodicalIF":2.8,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148851446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}