Neurosurgical focus最新文献

{"title":"Single-session versus staged approaches for chronic subdural hematoma treatment with middle meningeal artery embolization and evacuation surgery: a propensity score-matched analysis.","authors":"Santiago Gomez-Paz, Mohamed M Salem, Kent R Richter, Margaret McGrath, Jeffrey M Breton, Ahmed Aljuboori, Philipp Hendrix, Gregory M Weiner, Alana M McNulty, Jane Khalife, Okkes Kuybu, Michael J Lang, Omar Tanweer, Daniel A Tonetti, Christopher S Ogilvy, Alejandro M Spiotta, Ajith J Thomas, Bradley A Gross, Edward A M Duckworth, Jan-Karl Burkhardt, Visish M Srinivasan, Thomas Snyder, Brian T Jankowitz, Michael R Levitt, Rocco A Armonda, Daniel R Felbaum, Alexandra R Paul, William J Ares, Ramesh Grandhi","doi":"10.3171/2025.7.FOCUS25386","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25386","url":null,"abstract":"<p><strong>Objective: </strong>Surgical evacuation is the mainstay of treatment for patients with chronic subdural hematoma (cSDH) who have symptomatic mass effect, yet it carries a recurrence risk of up to 20%. Recent randomized trials have shown that adding middle meningeal artery embolization (MMAE) can significantly reduce both reoperations and overall treatment failures. However, whether performing MMAE and surgical evacuation in a single session impacts treatment efficacy remains an open question.</p><p><strong>Methods: </strong>The authors retrospectively identified 429 patients across 14 institutions who underwent MMAE plus surgical evacuation of cSDH. Patients were stratified into single-session (MMAE and evacuation under the same anesthesia session) or staged (separate sessions) cohorts. Baseline demographic, procedural, and imaging data were collected. Propensity score matching was performed to balance key baseline variables. Primary outcomes included hematoma recurrence, hospital length of stay (LOS), and functional independence (modified Rankin Scale score ≤ 2).</p><p><strong>Results: </strong>Of 429 patients, 205 (47.8%) received single-session treatment. In the unmatched analysis, single-session patients showed a lower rate of cSDH reaccumulation and repeat surgery (4.7% vs 10.7%, p = 0.010) and a shorter median LOS (6 vs 7 days, p < 0.005). After matching, reaccumulation rates were not significantly different, but LOS remained significantly shorter (5 vs 7 days, p = 0.002). Functional outcomes and overall mortality were similar in both groups. Complication rates did not differ, and MMAE-related adverse events were rare.</p><p><strong>Conclusions: </strong>Single-session MMAE plus surgical evacuation appears to be safe and shortens LOS compared with a staged approach. The rates of functional outcomes, re-evacuation, and mortality did not differ significantly from those observed in patients who underwent staged procedures.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E7"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206947","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":"Effect of the postoperative Trendelenburg position on chronic subdural hematoma recurrence: a pilot clinical trial.","authors":"Jorge H Montenegro, Santiago Ángel, Pablo A Botero, Juanita Salazar, Sonia M Rodríguez, Daniel Londoño, Óscar A Villada, Juan D Gutiérrez, Yeison E Montoya, Ignacio A González, Andrés M Rubiano","doi":"10.3171/2025.7.FOCUS25449","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25449","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to evaluate the effect of the postoperative Trendelenburg position on the recurrence of chronic subdural hematoma (CSH) in patients after surgical drainage.</p><p><strong>Methods: </strong>A pilot randomized, controlled clinical trial was conducted in 3 hospitals in Colombia. Patients with CSH were enrolled and assigned to a Trendelenburg position (30° leg elevation and 10° head tilt; intervention group) or to a flat position (control group) for 24 hours postoperatively. CSH recurrence was measured at 3 months, along with functional outcome (modified Rankin Scale [mRS] score), adverse events, and patient comfort.</p><p><strong>Results: </strong>Twenty-three patients were assigned to the Trendelenburg group and 23 to the control group. Two patients from the intervention group were assigned to the control group because of minor complications. Recurrence of CSH was 4.8% in the intervention group and 28.6% in the control group (p = 0.038). A favorable outcome (mRS score 0-2) was achieved in 95.2% of the intervention group versus 66.7% in the control group (p = 0.025). Patient comfort was equal in both groups (47.6% vs 48%, p = 0.979).</p><p><strong>Conclusions: </strong>In patients with CSH who require surgery, the postoperative Trendelenburg position is associated with lower recurrence and improved functional outcome at 3 months. Further studies are required to obtain more clinical evidence.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E5"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207002","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":"Chronic subdural hematoma enhanced recovery pathway: targeting excellent outcomes.","authors":"Srujana Venkata Vedicherla, Zakir Hassan Chew, Dave Thevandiran Kanavathy, Alethea Jern Ai Baskaran Nair, Christina Hui Ling Chia, Sarah Min Lim, Xiao Yuan Wu, David Chyi Yeu Low, Min Wei Chen, Jia Xu Lim","doi":"10.3171/2025.7.FOCUS25531","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25531","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (cSDH) is one of the most common neurosurgical pathologies. Despite the optimization of surgical approaches, outcomes such as recurrence and complication rates remain unacceptably high. Consolidated evidence-based pathways have demonstrated a clear impact on surgical outcomes. Herein, the authors aggregated literature evidence and institutional experience to design and implement an enhanced recovery pathway for cSDH.</p><p><strong>Methods: </strong>A multicenter cohort study was conducted over two periods: prior to (July 2021 to June 2022) and after (July 2022 to June 2023) pathway implementation. All adult patients with surgically evacuated cSDH or subacute subdural hematoma (SDH) were included in the study. Patients with SDHs that were managed conservatively, acute SDH treated with craniotomy or craniectomy, or subdural empyemas were excluded. Demographic details as well as preoperative clinical and radiological data were collected. Outcome measures included hospital length of stay (LOS), complication rate, discharge location, 30-day mortality, and 3-month recurrence. An excellent outcome was defined as discharge within a week of burr hole evacuation to a location similar to or better than premorbidly and no 3-month recurrence.</p><p><strong>Results: </strong>One hundred seventy prepathway and 169 postpathway patients were included in the final analysis and were comparable both demographically and clinically. After multivariable logistic regression analysis, the postpathway group had a shorter median LOS (9 vs 7 days, p = 0.003) and were more likely to be discharged to home or a rehabilitation facility (OR 2.77, 95% CI 1.45-5.56, p = 0.002). The 3-month recurrence rate reduced from 11.8% prepathway to 7.7% postpathway, although the difference between the two was not statistically significant (p = 0.13). Excellent outcomes were more likely postpathway, increasing from 34.7% to 49.7% (OR 1.92, 95% CI 1.19-3.13, p = 0.008).</p><p><strong>Conclusions: </strong>The treatment of cSDH is ever evolving with newer adjuncts and treatment modalities described in the literature. However, with the simple standardization of care in patients with cSDH, a reduced LOS, an optimized patient discharge location, and an increase in the proportion of patients with excellent outcomes were noted.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E6"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207180","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":"Letter to the Editor. Accurately predicting the determinants of local recurrence in patients with schwannomatosis-related schwannomas.","authors":"Juan Cao, Zhiming Shen","doi":"10.3171/2025.5.FOCUS25601","DOIUrl":"https://doi.org/10.3171/2025.5.FOCUS25601","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E15"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206955","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":"Embolization of the middle meningeal artery as a nonsurgical option for chronic subdural hematoma: a prospective matching study.","authors":"Arwed E Michael, Jana Rediker, Ulrich Knappe, Matthias M Woeltjen, Denise Schoenbeck, Jan Borggrefe, Christoph Moenninghoff","doi":"10.3171/2025.7.FOCUS25275","DOIUrl":"https://doi.org/10.3171/2025.7.FOCUS25275","url":null,"abstract":"<p><strong>Objective: </strong>Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a treatment option in addition or as an alternative to conservative or surgical therapy. The objective of this study was to investigate whether MMAE can be used as a primary treatment method in patients with CSDH without an acute indication for surgery, and as a therapeutic option instead of a reoperation in cases of recurrence after surgery.</p><p><strong>Methods: </strong>Fifty-one patients with MMAE as the primary treatment method for CSDH or for cases of recurrence after surgical treatment were prospectively included. A retrospective matching with patients treated only surgically was performed using the criteria of age, gender, size and side of the CSDH, as well as anticoagulation therapy. In the follow-up, the frequency of rescue operations and complications and the resumption of anticoagulation treatment were analyzed.</p><p><strong>Results: </strong>Eleven patients with MMAE and 14 controls underwent rescue surgery due to relevant worsening of symptoms (p = 0.638). None of the patients with MMAE experienced a complication, compared with 7 of the controls (p = 0.012). When anticoagulation treatment was resumed, there was a tendency in favor of MMAE (p = 0.058).</p><p><strong>Conclusions: </strong>There is a tendency toward superiority of MMAE for CSDH in certain patients. However, uncertainties remain regarding the exact methodology and optimal indications, and further research will be needed.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 4","pages":"E9"},"PeriodicalIF":3.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207004","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":"Microvascular decompression for hemifacial spasm involving a tortuous vertebral artery: a single-center 100-patient series with surgical nuances and literature review.","authors":"Koichi Iwasaki, Naoya Yoshimoto, Kazushi Kitamura, Isao Sasaki, Hiroki Toda","doi":"10.3171/2025.6.FOCUS25303","DOIUrl":"10.3171/2025.6.FOCUS25303","url":null,"abstract":"<p><strong>Objective: </strong>Hemifacial spasm (HFS) is occasionally caused by neurovascular compression (NVC) from a tortuous and elongated vertebral artery (VA), often with dolichoectatic changes. The aim of this study was to determine whether patients with HFS and VA involvement as an offending vessel exhibit clinicosurgical features distinct from those patients without VA involvement.</p><p><strong>Methods: </strong>Demographics, clinical and surgical characteristics, and treatment outcomes of consecutive patients who underwent microvascular decompression (MVD) for HFS at a single institution from October 2011 to December 2016 were retrospectively reviewed. In addition, relevant publications were reviewed for the clinicosurgical characteristics of patients with HFS and tortuous VA involvement.</p><p><strong>Results: </strong>Of 279 included patients (192 female, mean age 53.9 years), 100 (35.8%) had involvement of a tortuous VA as the offending vessel (VA+ group) and 179 (64.2%) did not (VA- group). The VA+ group had a significantly higher proportion of males (OR 2.01, 95% CI 1.19-3.38; p = 0.01) and significantly higher left-sided preponderance (OR 0.37, 95% CI 0.22-0.62; p = 0.002) compared with the VA- group. For 3 patients (3%) in the VA+ group, the VA was the sole offending vessel responsible for HFS, while the remaining 97 patients (97%) had multiple offending vessels involved, including the anterior inferior cerebellar artery (AICA) and/or posterior inferior cerebellar artery (PICA). Compared with the VA- group, the VA+ group had a higher percentage of PICA involvement (50% vs 33%) and lower percentage of AICA involvement (61% vs 78.2%). No significant difference was observed in the surgical outcomes (p = 0.58) or incidence of complications (p = 0.90) between the two groups. Additionally, the literature review indicated that patients with HFS and tortuous VA involvement in previous studies tended to show a weaker female preponderance and a stronger left-sided predominance compared with those without VA involvement.</p><p><strong>Conclusions: </strong>Patients with HFS involving the VA as the offending vessel had distinct clinicosurgical features compared with those without VA compression. Furthermore, during MVD for VA-involved HFS, special attention is required to avoid missing concurrent small arteries beneath the VA on the NVC site of the affected facial nerve.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E2"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963007","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":"Recurrent trigeminal neuralgia following MVD: a meta-analysis of second-line treatment strategies.","authors":"Asfand Baig Mirza, Feras Fayez, Ariadni Georgiannakis, Emilia Olszewska, Natalia Olszewska, Davide Del Duca, Amisha Vastani, Christoforos Syrris, Jonathan Pollock","doi":"10.3171/2025.6.FOCUS25438","DOIUrl":"10.3171/2025.6.FOCUS25438","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare pain outcomes and complication rates between reexploration microvascular decompression (MVD), percutaneous rhizotomy (PR), and stereotactic radiosurgery (SRS) as second-line treatments for recurrent or persistent trigeminal neuralgia (TN) following an initial MVD.</p><p><strong>Methods: </strong>A systematic review and meta-analysis was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-Analysis of Observational Studies in Epidemiology) guidelines. Studies were included if they reported outcomes of reexploration MVD, PR, or SRS in adult patients with classic or idiopathic TN after a failed initial MVD. Primary outcomes included early and long-term pain relief. Secondary outcomes included recurrence, facial numbness, and complications. Random-effects models were used for meta-analyses, and subgroup and sensitivity analyses were conducted.</p><p><strong>Results: </strong>Twenty-seven studies including 886 patients were analyzed (MVD + MVD: 505; MVD + PR: 267; MVD + SRS: 114). Early pain relief rates were similar between the MVD + MVD (83%) and MVD + PR (88%) groups, but lower in the MVD + SRS (76%) group. Long-term pain relief was highest in the MVD + MVD (82%) group, followed by the MVD + PR (68%) and MVD + SRS (67%) groups. New facial numbness occurred most frequently in the MVD + PR (93%) group, compared with the MVD + MVD (29%) and MVD + SRS (12%) groups. Neurolysis during reexploration was associated with significantly improved pain outcomes (OR 4.0, p = 0.00017). No clinical variables significantly predicted early pain relief.</p><p><strong>Conclusions: </strong>Reexploration MVD provides durable long-term pain relief but carries a risk of complications. PR offers comparable short-term efficacy with higher rates of sensory disturbance but lower surgical morbidity. The benefit of nerve manipulation even in the absence of neurovascular compression highlights the need to better understand the pathophysiology of recurrent TN and supports the necessity for randomized controlled trials to inform treatment algorithms.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E16"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962976","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":"Introduction. Vascular compression syndromes and their management.","authors":"Henry W S Schroeder, Marc Sindou, Raymond F Sekula, Joachim K Krauss, Giovanni Broggi","doi":"10.3171/2025.6.FOCUS24677","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS24677","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E1"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962928","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":"Comparison of endoscope, exoscope, and microscope visualization during microvascular decompression for trigeminal neuralgia: a single-center experience of 135 surgeries.","authors":"Dallas E Kramer, Caitlin Barrett, Jose Sandoval-Consuegra, Bhavika Gupta, Jenna Li, Seung W Jeong, Rocco Dabecco, Hamid Borghei-Razavi, Hae-Dong Jho, Alexander Yu","doi":"10.3171/2025.6.FOCUS25419","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25419","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Microscopic microvascular decompression (MVD) is an effective, long-lasting treatment for trigeminal neuralgia (TN). Endoscopic MVD has shown comparable outcomes while identifying neurovascular compression in up to 28% of cases otherwise missed with the microscope. The extracorporeal telescope (exoscope) represents the newest visualization technique available to neurosurgeons, offering enhanced ergonomics and trainee education. The authors compared their institution's experience with endoscope-, exoscope-, and microscope-assisted MVD for TN.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors retrospectively reviewed all MVD procedures performed for primary TN at a single, tertiary care teaching hospital between 2016 and 2024, categorized by intraoperative visualization method. Cases were assessed for baseline demographics, intraoperative findings, surgical time, pre- and postoperative Barrow Neurological Institute (BNI) pain intensity scores, length of stay, and postoperative complications. Statistical analysis was performed using ANOVA for continuous variables and the chi-square or Fisher's exact test for categorical variables (p &lt; 0.05), and any variables determined to be significant were subsequently evaluated using post hoc analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 135 cases were included (27 endoscope, 54 exoscope, 54 microscope). Demographics and preoperative symptoms were similar among groups. Surgical time was significantly shorter with the endoscope (134.3 minutes) than with the exoscope (164.8 minutes, p = 0.01) and microscope (161.1 minutes, p = 0.03). Patients in the endoscope cohort were less likely to receive intraoperative neurolysis (p &lt; 0.005) or experience intraoperative monitoring changes (p &lt; 0.005). The offending compressive vessel was most commonly a venous structure (50%) and/or the superior cerebellar artery (49%). The endoscope and exoscope identified ≥ 2 compressive vessels (52% and 48%, respectively, vs 39%; p = 0.46) more often, with fewer instances of absence of vascular compression of the TN (4% and 6%, respectively, vs 13%; p = 0.35), than the microscope, although this failed to meet statistical significance. Fewer endoscope cases than exoscope and microscope cases experienced immediate pain relief (89% vs 98% and 100%, respectively; p &lt; 0.001); however, there was no difference in postoperative BNI pain scores (p = 0.20) or change in BNI pain scores from preoperatively (p = 0.68). The rate of complications was lower with the endoscope and exoscope than with the microscope (4% and 2%, respectively, vs 15%; p = 0.04). CSF leak (7%) was the most common complication in the microscope cohort.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Clinical outcomes were equivalent among all visualization techniques. Surgical time was shorter with the endoscope. The endoscope and exoscope were associated with fewer postoperative complications than the microscope. The endoscope and exoscope identified ≥ 2 com","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E17"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962940","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":"Intraoperative blink reflex monitoring during skull base surgery: a single-institution method.","authors":"Tanner J Zachem, Holly Johnson, Syed M Adil, Hannah Scruggs, Patrick J Codd, Aatif M Husain, Ali Zomorodi, C Rory Goodwin, Jihad Abdelgadir","doi":"10.3171/2025.6.FOCUS25414","DOIUrl":"https://doi.org/10.3171/2025.6.FOCUS25414","url":null,"abstract":"<p><strong>Objective: </strong>Cranial nerve (CN) preservation remains a challenge for skull base neurosurgeons, and neurophysiological intraoperative monitoring presents many methods for CN identification and mapping. The blink reflex, which is the electrophysiological representation of the corneal reflex, can be used to test both trigeminal and facial nerve function. The objective of this study was to present a method for obtaining a reliable blink reflex response and maintaining it during the course of a procedure.</p><p><strong>Methods: </strong>A method for robust blink reflex recording is presented. Electrode placement, recording parameters, stimulation parameters, anesthetic considerations, and reliability troubleshooting are described.</p><p><strong>Results: </strong>This method has been iteratively developed at the authors' institution across multiple sites for more than 5 years. The blink reflex was monitored in multiple cranial approaches and for various pathologies. The most common cases monitored were vestibular schwannoma resections and microvascular decompressions. The most common cranial approaches were the translabyrinthine, retrosigmoid/suboccipital, and middle cranial fossa approaches.</p><p><strong>Conclusions: </strong>To gain a more comprehensive understanding of the clinical utility of the blink reflex in surgical decision-making and outcome prediction, prospective studies involving larger patient cohorts are warranted. This report outlines a reproducible methodology and invites validation and constructive input from the broader neurosurgical and neuromonitoring communities.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"59 3","pages":"E18"},"PeriodicalIF":3.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144962936","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}