Neurosurgery最新文献

{"title":"Comparison of Triple Antiplatelet (Aspirin, Clopidogrel, and Cilostazol) and Modified Dual Antiplatelet (Aspirin and Low-Dose Prasugrel) Therapy in Patients With High On-Treatment Platelet Reactivity Undergoing Stent-Assisted Coil Embolization for an Unruptured Intracranial Aneurysm: A Prospective Randomized Clinical Trial.","authors":"Seung Pil Ban, O-Ki Kwon, Young Deok Kim, Hwan Seok Shim, Seung Bin Sung, Jae Seung Bang, Si Un Lee, Sang Hyo Lee, Tae Won Choi, Youngmi Park","doi":"10.1227/neu.0000000000003791","DOIUrl":"https://doi.org/10.1227/neu.0000000000003791","url":null,"abstract":"<p><strong>Background and objectives: </strong>Modified antiplatelet therapies in patients with high on-treatment platelet reactivity (HTPR) remains unknown in neurointerventional treatment. We aimed to compare the safety and effectiveness of two different modified antiplatelet therapies in patients with HTPR undergoing stent-assisted coil embolization for an unruptured intracranial aneurysm.</p><p><strong>Methods: </strong>We conducted a prospective, randomized clinical trial. Participants with HTPR were randomly assigned (1:1) to the triple antiplatelet therapy (TAT, addition of cilostazol) or modified dual antiplatelet therapy (MDAT, switched from clopidogrel to low-dose prasugrel) group. The primary outcome was all-bleeding-events during the 90-day follow-up period. The secondary outcomes were thromboembolic events and changes in the P2Y12 reaction unit (PRU) value throughout the follow-up period. Intention-to-treat (ITT) and per-protocol (PP) analyses were performed.</p><p><strong>Results: </strong>In total, 172 of the 198 participants maintained initial antiplatelet therapy for 90 days. There was no significant difference in the all-bleeding-event rate between the two groups, both in the ITT population (hazard ratio [HR], 0.77 [95% CI, 0.49-1.20]; P = .26) and the PP population (HR, 0.79 [95% CI, 0.50-1.30]; P = .34). The thromboembolic event rate did not differ between the 2 groups in either the ITT population (HR, 0.33 [95% CI, 0.03-3.20]; P = .34) or the PP population (HR, 0.42 [95% CI, 0.04-4.70]; P = .48). Compared with those in the TAT group, the PRU values in the MDAT group greatly decreased over time, particularly for PRU after loading.</p><p><strong>Conclusion: </strong>Among patients with HTPR who underwent stent-assisted coil embolization for an unruptured intracranial aneurysm, there was no significant difference between the TAT and MDAT groups regarding the risk of all bleeding events and thromboembolic events during the 90 days of follow-up.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275448","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":"Commentary: Long-Term Clinical Benefits of Age-Adjusted Sagittal Correction in Adult Spinal Deformity Surgery: Results From Patient Grouping Using a Hierarchical Cluster Analysis.","authors":"Wiley B Gillam, Connor E Rupp, Zachary A Sorrentino, Steven G Roth, Julie L Chan","doi":"10.1227/neu.0000000000003808","DOIUrl":"https://doi.org/10.1227/neu.0000000000003808","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275402","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":"Predictive Values of Lumbar Infusion Testing in Idiopathic Normal Pressure Hydrocephalus Diagnosis.","authors":"Antoine Keraudy, Luc Defebvre, Gregory Kuchcinski, Philippe Bourgeois, Marc Baroncini","doi":"10.1227/neu.0000000000003797","DOIUrl":"https://doi.org/10.1227/neu.0000000000003797","url":null,"abstract":"<p><strong>Background and objectives: </strong>Idiopathic normal-pressure hydrocephalus (iNPH) remains a diagnostic challenge because of the lack of a single reliable diagnostic test. The aim of this study was to evaluate the performance of the lumbar infusion test (LIT) in the decision-making process for shunting in patients with suspected iNPH.</p><p><strong>Methods: </strong>A total of 201 patients with suspected iNPH underwent complete clinical, radiological, and hydrodynamic evaluation, including LIT, between January 2016 and January 2024 at Lille University Hospital. Patients were categorized into unlikely, possible, or probable iNPH groups before and after LIT. The decision to shunt was made in a multidisciplinary setting. The sensitivity, specificity, and predictive values of the resistance coefficient (Rout) thresholds were analyzed. Clinical outcomes after shunting were assessed using the Larsson categorization, walking test, and Mini-Mental State Examination.</p><p><strong>Results: </strong>Among 165 patients who completed an interpretable LIT for iNPH diagnosis suspicion, the mean age was 79 years. Gait disturbances were present in 98.8%, cognitive impairment in 86.6% and urinary disturbances in 58.8% of cases. The mean Rout values varied significantly across the diagnostic groups (P < .0001). The optimal threshold for Rout was determined to be 12 mm Hg/mL/min, with a sensitivity of 78.1% and specificity of 74.3% (area under the curve = 0.8441, P < .0001). Among 41 patients in the possible iNPH group who underwent shunting based on LIT findings, 75.6% demonstrated clinical improvement. In the probable iNPH group, 87.1% of shunted patients showed improvement. None of the unlikely patients with iNPH with negative LIT results underwent surgery.</p><p><strong>Conclusion: </strong>Although LIT does not provide a definitive diagnosis of iNPH, it serves as a safe and valuable adjunct in cases of diagnostic uncertainty, aiding in early decision making and potentially improving postshunting outcomes. Its reproducibility, ease of implementation, and low morbidity make it a useful tool in the diagnosis of iNPH when combined with clinical and radiological assessments.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275478","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":"Real-Time Artificial Intelligence-Assisted Middle Meningeal Artery Embolization Using Liquid Embolic Agents for Chronic Subdural Hematoma: A Preliminary Experience.","authors":"Kenichi Kono, Yuya Sakakura, Takeshi Fujimoto","doi":"10.1227/neu.0000000000003790","DOIUrl":"https://doi.org/10.1227/neu.0000000000003790","url":null,"abstract":"<p><strong>Background and objectives: </strong>Middle meningeal artery (MMA) embolization is an emerging treatment option for chronic subdural hematoma. Surgeons must pay close attention to multiple vessels when using liquid embolic agents to avoid complications. Unintended embolization through dangerous anastomotic connections can result in serious complications, such as visual loss or cranial nerve dysfunction. In this study, we report our preliminary experience with real-time artificial intelligence (AI)-assisted MMA embolization and evaluate its performance.</p><p><strong>Methods: </strong>An AI-based system (iMed Technologies) was used for 19 lesions in 15 patients at 2 institutions, with 4 patients receiving bilateral treatment. The software automatically detects liquid embolic agents in biplane fluoroscopy images in real-time and notifies operators when the agent reaches any of the predefined areas. The safety, efficacy, and accuracy of the notifications were retrospectively evaluated using recorded videos.</p><p><strong>Results: </strong>A total of 36 MMA branches were embolized using n-Butyl-2-cyanoacrylate. The mean true positives, false negatives, and false-positive notifications per vessel embolization were 8.9, 1.6, and 0.9, respectively. The precision and recall of the notifications were 90.9% and 84.9%, respectively. In 40.2% of the true-positive notifications, operators immediately paused agent injection after receiving the notification, demonstrating potential clinical effectiveness of the AI system. No adverse events were reported.</p><p><strong>Conclusion: </strong>To our knowledge, this is the first study to examine MMA embolization for chronic subdural hematoma with real-time AI assistance. The system demonstrated high notification accuracy, safety, and potential clinical usefulness for liquid embolization procedures. Large-scale prospective studies are warranted to validate the impact on clinical outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252187","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 Pallidal and Subthalamic Stimulation for Cranial Cervical Dystonia: A 4-Year Follow-up Study.","authors":"Jiansong Huang, Hutao Xie, Yin Jiang, Quan Zhang, Tao Xue, Ming Shan, Yutong Zhuang, Guofan Qin, Zhaoting Zheng, Defu Liu, Hao Zhang, Honghao Zhang, Sizhe Li, Yuxin Wang, Anchao Yang, Fangang Meng, Yutong Bai, Jianguo Zhang, Hua Zhang","doi":"10.1227/neu.0000000000003783","DOIUrl":"https://doi.org/10.1227/neu.0000000000003783","url":null,"abstract":"<p><strong>Background and objectives: </strong>Deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) or subthalamic nucleus (STN) is well established for treatment of craniocervical dystonia (CCD). This study aims to compare the long-term outcomes of GPi-DBS and STN-DBS for CCD and identify potential prognostic factors.</p><p><strong>Methods: </strong>This retrospective study analyzed 78 consecutive patients with CCD treated with bilateral DBS at a single medical center, comprising 2 nonrandomized cohorts: GPi-DBS (n = 38) and STN-DBS (n = 40). Motor and nonmotor symptoms were assessed using standardized rating scales at baseline, 6 months, and 1, 2, 3, and 4 years after surgery. Multiple linear and logistic regression analyses were performed to identify potential prognostic factors for long-term outcomes.</p><p><strong>Results: </strong>At 6 months, the STN group showed greater improvement in motor symptoms compared with the GPi group (50.48% [95% CI, 40.12%-60.84%] vs 34.92% [95% CI, 24.84%-45.00%], P = .046), although this difference was not significant after adjusting for multiple comparisons (threshold P < .01). No significant differences in motor symptom improvement were observed between the 2 groups at later follow-up points. Among all Burke-Fahn-Marsden dystonia rating scale movement subscale scores, the STN group showed greater improvement in the eye subscore at 6 months, 2 years, 3 years, and 4 years, but these differences were also not significant after adjusting for multiple comparisons. Both groups demonstrated significant improvements in mood and quality of life at the last follow-up. Cognitive functions remained stable. Multiple regression analysis revealed a negative correlation between disease duration and motor improvement (standardized β = -.023, 95% CI, -0.044% to -0.003%, P = .028).</p><p><strong>Conclusion: </strong>Both GPi- and STN-DBS can effectively improve motor symptoms and quality of life of patients with CCD, with comparable long-term efficacy. Early intervention is critical, with disease duration being an important prognostic factor for long-term motor improvement.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252102","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: Rise of the Machines: The Promise and Peril of AI in Medical Literature.","authors":"Brian F Saway, Mohammad Mahdi Bagheri Asl, Jamie R F Wilson, Alejandro M Spiotta","doi":"10.1227/neu.0000000000003782","DOIUrl":"https://doi.org/10.1227/neu.0000000000003782","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252107","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":"Impact of Psychiatric Comorbidities on Healthcare Resource Utilization in Patients Undergoing Venous Sinus Stenting for Idiopathic Intracranial Hypertension.","authors":"Joanna M Roy, Basel Musmar, Sydney Macon, Keenan Piper, Nikita Nair, Saman Sizdahkhani, Spyridon Karadimas, Robert H Rosenwasser, Stavropoula I Tjoumakaris, Pascal Jabbour, M Reid Gooch","doi":"10.1227/neu.0000000000003776","DOIUrl":"https://doi.org/10.1227/neu.0000000000003776","url":null,"abstract":"<p><strong>Background and objectives: </strong>Venous sinus stenting (VSS) is used to treat medically refractory idiopathic intracranial hypertension (IIH). Psychiatric comorbidities, including anxiety, depression, and personality disorders, are commonly seen in patients with IIH due to the chronic nature of their symptoms. Our study analyzes the impact of psychiatric comorbidities on healthcare resource utilization after VSS for IIH.</p><p><strong>Methods: </strong>This was a retrospective study using the TriNetX database to identify patients who underwent VSS for IIH. Patients were stratified based on the presence or absence of psychiatric comorbidities such as schizophrenia, affective disorders, anxiety, and behavioral syndromes associated with psychological disturbances and personality disorders. Propensity score matching was used to adjust for baseline differences between the two cohorts. Outcomes of interest were repeat surgical intervention, emergency department (ED) visits, and symptoms such as papilledema, headache, vision changes, or pulsatile tinnitus. Propensity score matching was used to adjust for baseline differences between the 2 cohorts.</p><p><strong>Results: </strong>Of 1468 patients who underwent VSS, 840 patients (57.2%) had psychiatric comorbidities and 628 patients (42.8%) did not have any psychiatric comorbidities. After propensity score matching for baseline demographics and preoperative symptoms of IIH, patients with psychiatric comorbidities had higher odds of repeat surgical interventions (odds ratio [OR] = 1.681, 95% CI 1.090-2.589, P = .017), ED visits (OR = 1.727, 95% CI: 1.250-2.386, P < .001), and headaches (OR = 1.834, 95% CI: 1.235-2.722, P = .002) after VSS compared with those without psychiatric comorbidities. There were no significant differences in odds of papilledema (OR = 0.987, 95% CI: 0.719-1.355, P = .935), visual changes (OR = 1.186, 95% CI: 0.873-1.611, P = .274), or pulsatile tinnitus (OR = 1.314, 95% CI: 0.829-2.081, P = .243).</p><p><strong>Conclusion: </strong>IIH patients with psychiatric comorbidities experience higher rates of ED visits, repeat surgical intervention, and headaches after VSS. These findings highlight the importance of considering psychiatric comorbidities during preoperative counselling and in planning postoperative care for this population.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252184","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":"Repeat Stereotactic Body Radiation Therapy for Spinal Metastases: Long-Term Outcomes and Toxicity.","authors":"Suchet Taori, Samuel Adida, Serah Choi, Travis J McCaw, Steven A Burton, John C Flickinger, Roberta K Sefcik, Peter C Gerszten","doi":"10.1227/neu.0000000000003772","DOIUrl":"https://doi.org/10.1227/neu.0000000000003772","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although stereotactic body radiation therapy (SBRT) provides durable local tumor control, management after cases of local failure (LF) continues to remain unclear. This study is one of the largest to report outcomes after a repeat course of spine SBRT after initial SBRT LF.</p><p><strong>Methods: </strong>A prospectively maintained single-institution database of patients treated with SBRT was analyzed. Inclusion criteria consisted of patients with spinal metastases who underwent a repeat course of SBRT for same vertebral-level LF after initial SBRT. The median dose for repeat SBRT was 16 Gy (range: 12-30) in 1-3 fractions.</p><p><strong>Results: </strong>A total of 55 patients with 67 metastases met inclusion criteria. Of these, 45 metastases (67%) were irradiated with conventional external beam radiation therapy (cEBRT) before the initial SBRT. The median interval between initial and repeat SBRT was 8 months (range: 2-125). Rates of 6-month, 1-year, and 2-year local control were 96%, 85%, and 77%, respectively. On univariable analysis, only previous cEBRT (P = .014, hazard ratio [HR]: 0.13, 95% CI: 0.02-0.66) was associated with superior local control. Rates of 6-month, 1-year, and 2-year overall survival (OS) were 69%, 53%, and 35%, respectively. Univariable analysis identified age ≤65 years (P = .036, HR: 1.74, 95% CI: 1.04-2.93) and Karnofsky Performance Score >70 (P = .038, HR: 0.57, 95% CI: 0.33-0.97) as associated with superior OS. No tested prognostic factors remained associated with OS on multivariable analysis. Clinical improvement or stability of pain was observed after 95%, 82%, and 75% of treatments at 3, 6, and 12 months, respectively. Accounting for the competing risk of death, the 6-month, 1-year, and 2-year vertebral compression fracture cumulative incidence rates were 6%, 20%, and 25%, respectively. No radiation neuropathy or myelopathy was observed in the follow-up period.</p><p><strong>Conclusion: </strong>Repeat SBRT is a safe and effective salvage therapy for patients with recurrent spinal metastases after initial same vertebral-level SBRT LF, even in heavily pretreated patients previously irradiated with cEBRT.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239491","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":"Commentary: Defensive Medicine in Neurosurgery: The Sub-Saharan Africa Experience.","authors":"Nasser M F El-Ghandour","doi":"10.1227/neu.0000000000003789","DOIUrl":"https://doi.org/10.1227/neu.0000000000003789","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239510","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":"Upfront Stereotactic Radiosurgery for Nonfunctioning Pituitary Neuroendocrine Tumors: An International, Multicenter Study.","authors":"Chloe Dumot, Georgios Mantziaris, Sam Dayawansa, Selcuk Peker, Yavuz Samanci, Ahmed M Nabeel, Wael A Reda, Sameh R Tawadros, Khaled AbdelKarim, Amr M N El-Shehaby, Reem M Emad, Ahmed Ragab Abdelsalam, Roman Liscak, Jaromir May, Elad Mashiach, Fernando De Nigris Vasconcellos, Kenneth Bernstein, Douglas Kondziolka, Herwin Speckter, Ruben Mota, Anderson Brito, Shray Kumar Bindal, Ajay Niranjan, L Dade Lunsford, Carolina Gesteira Benjamin, Timoteo Almeida, Jennifer Mao, David Mathieu, Jean-Nicolas Tourigny, Manjul Tripathi, Joshua David Palmer, Jennifer Matsui, Joseph Crooks, Rodney E Wegner, Matthew J Shepard, Jason P Sheehan","doi":"10.1227/neu.0000000000003799","DOIUrl":"https://doi.org/10.1227/neu.0000000000003799","url":null,"abstract":"<p><strong>Background and objectives: </strong>Upfront stereotactic radiosurgery (SRS) could be an option for nonfunctioning pituitary adenomas (NFPA) unsuitable for surgery. Only small series evaluate the results of upfront SRS; the aim of the study was to report patient outcomes from a large, international patient cohort.</p><p><strong>Methods: </strong>The study evaluated tumor control and complications after single-session SRS in a multicentric cohort of untreated NFPA.</p><p><strong>Results: </strong>In total, 132 patients (median age 51.2 [IQR: 27.1] years at SRS, median volume 2.1 [IQR: 2.9] cm3) were included. The probability of tumor control was 100% (95% CI: 100-100), 98.1% (95% CI: 94.6-100), and 92.4 (95% CI: 81.6-100) at 3, 5, and 8 years after SRS. The cumulative probability of new pituitary deficit was 11.7% (95% CI: 3.8-18.9), 24.4% (95% CI: 12.1-35.1), and 29.5% (95% CI: 12.1-26.9) at 3, 5, and 8 years, respectively. No new visual field defect occurred. Before SRS, 50 patients (37.9%) presented with a visual field defect with a complete improvement in 17 (34.7%), partial improvement in 12 (24.5%), and stability in 19 (38.8%) at a last follow-up of 2.2 (3.9) years. One patient (2.0%) worsened after SRS. Before SRS, 10 patients (7.6%) presented with an oculomotor nerve palsy. One patient (0.8%) developed a new transient nerve palsy. At a last follow-up of 2.5 (4.4) years, 5 patients (45.4 35.7%) had a stability of their palsy, 1 had a partial improvement (9.1%), and 5 (45.4%) had a complete improvement.</p><p><strong>Conclusion: </strong>Upfront SRS represents an option for appropriately selected patients with NFPA, and it exhibits a favorable efficacy and safety profile, but a longer follow-up is required. Visual improvement is low, and careful selection of patient is required.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239457","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}