Neurosurgery最新文献

{"title":"Open Door Versus Double Door Laminoplasty in the Treatment of Cervical OPLL: A 10-Year Retrospective Analysis.","authors":"Sun-Joon Yoo, Jun Jae Shin, Hyun-Jun Jang, Kyung-Hyun Kim, Jeong-Yoon Park, Sung Uk Kuh, Dong-Kyu Chin, Keun-Su Kim, Bong Ju Moon","doi":"10.1227/neu.0000000000003970","DOIUrl":"10.1227/neu.0000000000003970","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study compared the surgical outcomes of open-door (OD) and double-door (DD) laminoplasties in patients with cervical ossification of the posterior longitudinal ligament (OPLL).</p><p><strong>Methods: </strong>This single-center study included 62 patients in the OD group and 47 patients in the DD group, all of whom were evaluated over a 10-year follow-up period. We assessed demographics, surgical levels, occupying ratio, K-line classification, type of OPLL, C2-C7 Cobb angle, cervical OPLL volume, and range of motion (ROM). Clinical outcomes were assessed using visual analog scale score, Japanese Orthopedic Association (JOA) score, and recovery rate.</p><p><strong>Results: </strong>No significant differences were observed in age, sex, symptom duration, comorbidities, K-line type, and canal-occupying ratio. Six patients in each group underwent reoperation. The C2-7 Cobb angle remained similar preoperatively, immediately after surgery, or 2 years after surgery. At the 10-year follow-up, the extension angle and ROM were significantly lower in the DD group, although the overall ROM change from baseline was not significant different. OPLL volume was significantly greater in the OD group at 10 years. The visual analog scale scores for the neck and arm were significantly lower in the DD group than in the OD group immediately after surgery, with no difference between the groups at 10 years postsurgery. The JOA scores showed a similar improvement at 10 years postoperatively.</p><p><strong>Conclusion: </strong>Both laminoplasty methods were effective for long-term treatment of cervical OPLL, providing similar clinical outcomes and improvement in the JOA score over a 10-year follow-up period. However, the ROM decreased significantly more in the DD group than in the OD group, especially in patients younger than 50 years of age. These findings suggest that, although both techniques are viable options, patient age and preservation of cervical ROM may be important considerations in the choice of surgical method.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1159-1171"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290566","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: T2-Weighted MRI Signal Intensity Ratio Predicts Intraoperative Meningioma Consistency: A Retrospective Cohort Study.","authors":"Nasser M F El-Ghandour","doi":"10.1227/neu.0000000000004129","DOIUrl":"10.1227/neu.0000000000004129","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e59-e60"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252407","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":"Surgical Versus Medical Management for Severe Pediatric Traumatic Brain Injury: A Systematic Review and Meta-Analysis.","authors":"Leonardo Di Cosmo, Jad El Choueiri, Francesca Pellicanò, Oyku Ozsut, Jacopo Rosso Antonino, Ely Barak Feffer, Sangya Ghosh, Ali Darwiche, Christopher Peter Imbrogno, Santiago Nieto Cuervo, Salvatore Chibbaro, Ismail Zaed","doi":"10.1227/neu.0000000000003974","DOIUrl":"10.1227/neu.0000000000003974","url":null,"abstract":"<p><strong>Background and objectives: </strong>Decompressive craniectomy (DC) is used to control intracranial pressure in severe pediatric traumatic brain injury (TBI), although evidence of its benefit in pediatric patients remains conflicted. To address this, this meta-analysis evaluates the outcomes of DC vs medical management (MM) in pediatric severe TBI.</p><p><strong>Methods: </strong>Following PRISMA guidelines, databases were searched through October 2025 for studies comparing DC and MM in patients younger than 18 years with severe TBI. Randomized control trials and prospective and retrospective studies reporting at least one clinical outcome were included. Random-effects models were applied, with relative risks used for dichotomous outcomes and mean differences for continuous outcomes.</p><p><strong>Results: </strong>Our analysis included 553 DC and 2336 MM patients, with 1 randomized trial and 10 observational studies. Pooled analyses showed no significant difference in good functional outcomes between DC and MM, whether based on the Glasgow Outcome Scale or study-specific definitions or mortality (1.06, 95% CI 0.69-1.64; P = .78). Subgroup analyses of Glasgow Outcome Scale scores at discharge and 30 days corroborated these findings. DC was associated with a significantly longer intensive care unit stay (mean differences, 6.2 days, 95% CI 4.4-8.0; P < .001) and a similar trend toward longer hospital stay (mean differences, 4.0 days, 95% CI -0.6 to 8.7; P = .09), which became significant on sensitivity analysis. Reported complication rates, when reported, were low and comparable across groups.</p><p><strong>Conclusion: </strong>In children with severe TBI, DC does not appear to provide clear survival or functional advantages over MM and is significantly associated with longer intensive care unit and hospital stays. However, these findings should be interpreted with caution as the current literature mainly composed of small and heterogeneous retrospective studies. Further large, prospective, multicenter studies are needed to confirm these findings, refine surgical indications, and establish pediatric-specific management guidelines.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"973-985"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147390678","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":"Endovascular and Microsurgical Treatment for Middle Cerebral Artery Bifurcation Aneurysms: Experience From 10 High-Volume United States Cerebrovascular Centers.","authors":"Andre Monteiro, Vinay Jaikumar, Jaims Lim, Cathleen C Kuo, Louis J Kim, Michael R Levitt, Guilherme Barros, Alan S Boulos, Alexandra R Paul, Ricardo A Hanel, Eric Sauvageau, Gustavo M Cortez, Victor H C Benalia, Chris Nickele, Kendrick Johnson, Pascal M Jabbour, Kareem El Naamani, Clemens M Schirmer, Diogo C Haussen, Jonathan A Grossberg, Mahmoud H Mohammaden, Tudor G Jovin, Jane Khalife, Peter T Kan, Marco Colasurdo, Margaret McGrath, Ché Ross, Michael Yeradi, Monica Devaraju, Isaac Stafstrom, Jason M Davies, Elad I Levy, Adnan H Siddiqui","doi":"10.1227/neu.0000000000003967","DOIUrl":"10.1227/neu.0000000000003967","url":null,"abstract":"<p><strong>Background and objectives: </strong>Middle cerebral artery bifurcation (MCAb) aneurysms have primarily been managed through microsurgical clipping (MC). However, the effectiveness and safety of evolving neurointerventional methods warrant a comprehensive examination and comparison with MC. We investigated patient and MCAb aneurysm characteristics and compared imaging outcomes for MC, simple coiling (SC), stent-assisted coiling (SAC), flow-diverting stent placement (FD), and endosaccular flow disruption.</p><p><strong>Methods: </strong>A retrospective review of MCAb aneurysm databases from 10 US centers was conducted to identify patients treated between January 2008 and January 2023. Primary analyses compared data across all 5 treatment modalities individually and for MC vs endovascular modalities. Secondary analyses consisted of pairwise comparisons between these modalities for saccular MCAb aneurysms.</p><p><strong>Results: </strong>We analyzed data for 1060 patients with 1060 MCAb aneurysms (MC = 722, SC = 134, SAC = 106, FD = 34, and endosaccular flow disruption = 64). The treatment groups differed significantly in mean patient age ( P < .001), sex distribution ( P = .044), and baseline mRS score ( P < .001). No treatment preference was noted for recurrent aneurysms. Ruptured aneurysms were most common in SC and least common in FD ( P < .001). Wide-necked aneurysms were most frequent in FD ( P < .001). Intraoperative complications were similar, although SAC had more vasospasm ( P = .006) and device-related complications ( P = .010), and FD had more thromboembolic events ( P = .047). Postoperative complications varied ( P = .007): MC had more vasospasm ( P = .043). Follow-up durations varied significantly ( P < .001). Follow-up complications differed ( P = .012): FD had more transient ischemic attacks ( P = .042) and ischemic strokes ( P < .001); SC had more aneurysmal rehemorrhage ( P = .027). Immediate and final aneurysmal occlusion was considerably better with MC ( P < .001), followed closely by SAC.</p><p><strong>Conclusion: </strong>MC remained the preferred modality for treating both unruptured and ruptured MCAb aneurysms, demonstrating superior immediate and final angiographic occlusion rates with minimal intraoperative and postoperative complications. SAC showed similar safety but was technically more challenging, FD had higher ischemic event rates, and SC had more delayed reruptures.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1136-1148"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146258620","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":"Machine Learning Methods to Identify Pediatric Shunt Malfunction in the Acute Care Setting and the Development of ShuntGPT.","authors":"Kurt R Lehner, Anita L Kalluri, Kelly Jiang, Rama J Alawneh, Ryan P Lee, Foad Kazemi, Joan Yea, Sai Chandan Reddy, Jacob S Shaw, Eric M Jackson","doi":"10.1227/neu.0000000000003962","DOIUrl":"10.1227/neu.0000000000003962","url":null,"abstract":"<p><strong>Background and objectives: </strong>Identifying predictors of shunt failure in acute care settings is challenging. Previous studies largely rely on traditional statistical analyses to evaluate risk factors associated with shunt failure. However, these methods have not been adapted for emergency department (ED) presentations, where machine learning (ML) techniques may offer enhanced predictive power. Thus, we explored the application of ML and artificial intelligence in predicting necessity for shunt revision in pediatric ED visits.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 1167 pediatric neurosurgical consults for suspected shunt malfunction from 2017 to 2022. We collected 24 historical, clinical, and radiographic variables. Various ML techniques were used, including support vector machine, K-nearest neighbors, random forest, an artificial neural network (ANN), and a proprietary large language model named ShuntGPT (SGPT), which classifies the need for shunt revision.</p><p><strong>Results: </strong>Among 1167 ED consults for shunt malfunction, 285 patients (24.4%) underwent revision. Multivariate analysis identified increased ventricle size, abnormal shunt series, lethargy, altered mental status, and bradycardia as predictors of need for revision. The best-performing ML models included ANN (accuracy 84%, area under the curve [AUC] 0.88, 71% sensitivity, 88% specificity) and SGPT (accuracy 87%, precision 0.80, recall 0.64, AUC 0.927). Traditional classifiers (support vector machine, K-nearest neighbors, random forest) achieved AUCs of 0.81 to 0.86 with varying trade-offs in sensitivity and precision. With imaging results removed from training data, the performance of all models suffered, however, SGPT retained a high level of discrimination (AUC 0.84). SGPT continued to show high accuracy (83%) on a separate validation cohort.</p><p><strong>Conclusion: </strong>Advanced ML models generally outperformed traditional statistical analyses, albeit with concerns about overfitting due to the extensive variable set. SGPT, in particular, showed superior performance, likely due to its capacity to interpret nuanced text. This model represents a promising tool to enhance decision-making in pediatric acute care settings regarding shunt malfunctions.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1211-1220"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202336","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: Reoperation Risk Factors for Cranioplasty Surgery.","authors":"Brian Kent, Brandon Lucke-Wold","doi":"10.1227/neu.0000000000004021","DOIUrl":"10.1227/neu.0000000000004021","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e61-e62"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593626","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: Clinical Outcomes of Subarachnoid Hemorrhage in Patients With Nicotine Dependence: A Longitudinal Study of 43 315 Patients.","authors":"Kenan Şimşek","doi":"10.1227/neu.0000000000004205","DOIUrl":"10.1227/neu.0000000000004205","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e72-e73"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148945534","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":"Decreasing Medicare Payments for Anterior Cervical Discectomy and Fusion From 2013 to 2023.","authors":"Jason Silvestre, Robert J Ferdon, Anthony J Minerva, John W Moore, James P Lawrence, Charles A Reitman, Robert A Ravinsky","doi":"10.1227/neu.0000000000003953","DOIUrl":"10.1227/neu.0000000000003953","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite its clinical utility and consistent procedural volume, Medicare reimbursement for anterior cervical discectomy and fusion (ACDF) has undergone policy-driven changes over the past decade. This study investigated longitudinal Medicare reimbursement trends for ACDF among orthopedic and neurological spine surgeons from 2013 to 2023.</p><p><strong>Methods: </strong>A retrospective analysis was performed using publicly available Centers for Medicare and Medicaid Services databases. Surgeons who billed ≥10 ACDF procedures (current procedural terminology 22551) per year were included. Provider demographics, procedural volumes, average Medicare standardized amount (AMSA), inflation-adjusted AMSA, and average annual procedural income (API) were analyzed. Comparisons were made by surgical subspecialty by year.</p><p><strong>Results: </strong>A total of 10 311 spine surgeons performed 187 062 ACDF procedures between 2013 and 2023. Neurosurgeons comprised 65% of providers and procedures, while orthopedic surgeons comprised 35%. Average annual case volumes were similar across specialties. Between 2013 and 2023, inflation-adjusted AMSA declined 23% and API declined 27%, despite stable procedural volumes. These declines were consistent across neurosurgeons (-23% AMSA, -27% API) and orthopedic surgeons (-22% AMSA, -27% API). The number of neurosurgeons performing ACDF decreased over the study period (17% decrease), while the number of orthopedic surgeons increased (31% increase). Both specialties saw a reduction in average procedures per provider.</p><p><strong>Conclusion: </strong>While unadjusted Medicare reimbursement for ACDF remained stable from 2013 to 2023, inflation-adjusted reimbursement declined substantially, reflecting an erosion in surgeon compensation. These findings raise concerns about the financial sustainability of providing ACDF services in the Medicare population and underscore the need for policy strategies that protect access to surgical care for an aging population.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1038-1046"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125771","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":"Large Language Model for Postoperative Clinical Decision Support in a Neurosurgery Ward in the Gambia: A Prospective Pilot Feasibility Study.","authors":"Saksham Gupta, Zsombor T Gal, Jay Touray, Gabrielle A Luiselli, Ancha Ceesay, Ebrima K Manneh, Makumba Cham, John D Rolston, Ryan Chrenek, Momodou G Bah, Alexandra J Golby, Ignatius N Esene, Omar Arnaout, Camejo Sanchez, Lamin Janneh, Timothy R Smith, John N Jabang","doi":"10.1227/neu.0000000000003963","DOIUrl":"10.1227/neu.0000000000003963","url":null,"abstract":"<p><strong>Background and objectives: </strong>Access to specialty surgical care is growing in many low-income countries, but it remains unclear how hospital workforces can leverage technology to manage large numbers of increasingly complex patients. Large language models (LLMs) may be helpful for this type of clinical decision support, but their real-world performance and safety remain uncertain. The objective of this study was to evaluate feasibility, usability, and potential benefits and risks of an LLM-based assistant for postoperative neurosurgical care in the Gambia.</p><p><strong>Methods: </strong>A prospective, single-arm implementation study was conducted at the Edward Francis Small Teaching Hospital. A convenience sample of 4 medical officers (MOs) and 5 nurses assigned to the neurosurgical service participated. A prompted GPT-4o Turbo was deployed on OpenAI Pro accounts to support performance. Usability, helpfulness, and safety were the primary outcomes. Cost-effectiveness was a secondary outcome.</p><p><strong>Results: </strong>Participants completed 75 LLM-assisted interactions on 9 postoperative neurosurgery patients. Usability metrics indicated a moderately high cognitive workload, marginally acceptable usability of the LLM system, and high perceived ease of use. Management plan quality improved in 45 of 75 mock rounds interactions (60%), with a mean improvement of 8.5% ( P < .001) on mock rounds scoring rubrics. The improvement was greater for MOs (21.0% change) than nurses (6.5% change). In hypothetical case dilemmas, MO plan accuracy improved by 22.7% ( P = .001), and critical errors declined from 33.3% to 0%. Fourteen care changes for 9 patients were attributed to LLM suggestions, including 6 that potentially prevented major morbidity. No unsafe outputs were detected. Exploratory cost analysis suggested potential savings from clinical care changes exceeded the labor costs involved in LLM use.</p><p><strong>Conclusion: </strong>LLM use was associated with improved plan quality without observed safety concerns, while also prompting clinically meaningful care changes. Larger, controlled studies are needed to determine generalizability, durability of benefit, and patient-centered outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1127-1135"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202247","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":"Electric-Scooters: An Emerging Source of High-Severity Pediatric Head Trauma: Corrigendum.","authors":"Pierre Petitet, Alessandra Musarra, Camilla de Laurentis, Pierre-Aurélien Beuriat, Alexandru Szathmari, Matthieu Vinchon, Sofia Guernouche, Etienne Javouhey, Federico Di Rocco","doi":"10.1227/neu.0000000000004207","DOIUrl":"10.1227/neu.0000000000004207","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e75"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796130","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}