Neurosurgery最新文献

{"title":"Association of Physical Activity and Obesity With the Risk of Degenerative Cervical Myelopathy.","authors":"Salim Yakdan, Alexander T Yahanda, Braeden Benedict, Jing Wang, Daniel Lilly, Ahmad Hammo, Faraz Arkam, Daniel Hafez, Jetan Badhiwala, Michael P Steinmetz, Thomas Mroz, Mohamad Bydon, Brian Neuman, Zoher Ghogawala, Wilson Z Ray, Jacob K Greenberg","doi":"10.1227/neu.0000000000004090","DOIUrl":"https://doi.org/10.1227/neu.0000000000004090","url":null,"abstract":"<p><strong>Background and objectives: </strong>Information about modifiable risk factors for degenerative cervical myelopathy (DCM) remains lacking. Although physical activity (PA) is a known risk factor for many chronic conditions, its role in DCM risk has not been studied. Therefore, this study investigated the association between PA and DCM risk.</p><p><strong>Methods: </strong>This was a retrospective analysis of data prospectively collected from the UK Biobank, with baseline assessments between 2006 and 2010. Participants were followed for a median duration of 13.8 years, with follow-up extending through 2022. PA was measured by self-reported questionnaires (International Physical Activity Questionnaire expressed as metabolic equivalent task minutes/week) and by accelerometer [mean acceleration and proportion of time spent in light and moderate-to-vigorous physical activity (MVPA)]. The primary outcome was the subsequent development of DCM. Cox proportional hazards models assessed associations between PA and DCM risk using IQR increase, with the 25th percentile as reference. Mediation analyses evaluated the role of body mass index (BMI).</p><p><strong>Results: </strong>In total, 357 056 participants (342 166 with self-reported PA and 84 762 with accelerometer-measured PA) were included. The mean patient age was 56.65 years, 53.03% were female, and 95.0% were White. Self-reported overall activity [hazard ratios (HR), 0.87; 95% CI: 0.82-0.93], MVPA (HR, 0.90; 95% CI: 0.85-0.96), and light activity (HR, 0.89; 95% CI: 0.84-0.95) were each inversely associated with DCM. In the accelerometer cohort, participants at the 75th percentile of mean acceleration had a 30% lower risk of DCM (HR, 0.70; 95% CI: 0.52-0.94) compared with those at the 25th percentile. Greater MVPA time was similarly associated with reduced DCM risk (HR, 0.81; 95% CI: 0.67-0.97). BMI partially mediated the association between PA and DCM.</p><p><strong>Conclusion: </strong>Higher PA levels were associated with reduced DCM risk, partially mediated through lower BMI. These findings highlight the potential of PA and BMI as modifiable risk factors for DCM.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841025","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 Extent of Resection on Overall Survival in World Health Organization Grade 4 Primary Spinal Cord Astrocytomas.","authors":"Xuanbo Shao, Zhuofan Xu, Penghao Liu, Lei Cheng, Maoyang Qi, Xiang Fang, Yang Feng, Zhenlei Liu, Kai Wang, Jian Guan, Zuowei Wang, Xingwen Wang, Hao Wu, Fengzeng Jian, Zan Chen, Wanru Duan","doi":"10.1227/neu.0000000000004088","DOIUrl":"https://doi.org/10.1227/neu.0000000000004088","url":null,"abstract":"<p><strong>Background and objective: </strong>Whether extent of resection (EOR) improves overall survival (OS) in World Health Organization (WHO) grade 4 primary spinal cord astrocytoma (SCA) remains controversial owing to limited and conflicting evidence. This study aimed to evaluate the impact of EOR on the prognosis of patients with WHO grade 4 primary SCA.</p><p><strong>Methods: </strong>We retrospectively analyzed 59 cases of WHO grade 4 primary SCA (2014-2024) to assess the impact of EOR on survival with subgroup analysis based on tumor location and Ki-67 expression.</p><p><strong>Results: </strong>In the whole cohort, Kaplan-Meier analysis showed no significant OS difference between the EOR ≥50% and EOR <50% groups (17 vs 10 months, P = .171). However, subgroup analyses found that EOR ≥50% significantly improved OS in noncervical SCA (36 vs 10 months, P = .034) and high Ki-67 SCA (16 vs 6 months, P = .016).</p><p><strong>Conclusion: </strong>This study demonstrates that the surgical benefit in WHO grade 4 primary SCA may be influenced by tumor location and Ki-67. We propose a hypothesis-generating conceptual framework to guide future research directions.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841035","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":"Glucagon-Like Peptide-1 Receptor Agonists and Outcomes After Intracerebral Hemorrhage in Patients With Type 2 Diabetes: A Propensity-Matched Cohort Study.","authors":"Fnu Ruchika, David Lee, James Feghali, Mansoor Alam, Harshal A Shah, Melanie Alfonzo Horowitz, Risheng Xu, Justin M Caplan, Christopher M Jackson, Judy Huang, Rafael J Tamargo, L Fernando Gonzalez","doi":"10.1227/neu.0000000000004079","DOIUrl":"https://doi.org/10.1227/neu.0000000000004079","url":null,"abstract":"<p><strong>Background and objectives: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have shown neuroprotective and anti-inflammatory effects in cerebrovascular disease, and previous studies suggest reduced stroke risk and overall mortality. This study compared post-intracerebral hemorrhage (ICH) outcomes in patients with type 2 diabetes mellitus (T2DM) receiving GLP-1RAs vs other hypoglycemic drugs including insulin.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the global TriNetX network database. Patients with ICH and T2DM were stratified by GLP-1RA exposure, initiation between 5 years before and the day of the ICH and compared with patients treated with other hypoglycemic agents. After 1:1 propensity matching, 3600 patients per cohort were included in the analysis. Outcomes were assessed at 7, 30, and 90 days (all-cause mortality, seizures, craniectomy/craniotomy procedures, and external ventricular drain placement) and at 1 and 5 years post-ICH (all-cause mortality, seizures, palliative care, and respiratory failure).</p><p><strong>Results: </strong>GLP-1RA use was associated with lower 7-day mortality (adjusted hazard ratio [AHR] 0.831, 95% CI 0.703, 0.983), 30-day mortality (AHR 0.835, 95% CI 0.741-0.942), and 90-day mortality (AHR 0.805, 95% CI 0.725-0.894). External ventricular drain insertion was not significantly different at any time point. Craniectomy/craniotomy and seizure risk were not significantly different at 7 or 30 days but were lower by 90 days (craniectomy/craniotomy: 2.8% vs 3.6%; AHR 0.763; seizures: 6.4% vs 7.7%; AHR 0.804). The mortality and seizure benefit persisted at 1 and 5 years. At 1 and 5 years, GLP-1RA use was also associated with reduced need for palliative care (1 year: 10.4% vs 13.1%; AHR 0.754; 5 years: 13.1% vs 16.1%; AHR 0.775) and respiratory failure (1 year: 19.8% vs 22.7%; AHR 0.825; 5 years: 25.2% vs 28.1%; AHR 0.854).</p><p><strong>Conclusion: </strong>In this cohort of patients with ICH and T2DM, GLP-1RA use was associated with improved outcomes. Prospective trials are warranted to confirm these observations.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840974","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: Individual Return to Work After Treatment of Vestibular Schwannoma: A Questionnaire-Based Study.","authors":"Mohammad Hassan A Noureldine, Kevin Akeret, Siviero Agazzi","doi":"10.1227/neu.0000000000004065","DOIUrl":"https://doi.org/10.1227/neu.0000000000004065","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840964","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":"Lumbar Puncture Opening Pressure and Continuous Intracranial Pressure Monitoring: Concordance and Clinical Implications in Idiopathic Intracranial Hypertension.","authors":"S Farzad Maroufi, Omkar Katkade, Pravarakhya Puppalla, Michael Meggyesy, Richard S Um, Sai Chandan Reddy, John N Theodore, Aruna Rao, Ryan P Lee, Mark G Luciano","doi":"10.1227/neu.0000000000004068","DOIUrl":"https://doi.org/10.1227/neu.0000000000004068","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lumbar puncture (LP) remains a standard diagnostic tool for assessing intracranial pressure (ICP) in idiopathic intracranial hypertension (IIH), yet it provides only a single static measurement that may not reflect dynamic pressure fluctuations. Although continuous ICP monitoring (ICPm) offers real-time assessment of postural and circadian variability, the relationship between LP and ICPm measurements done after nondiagnostic LP remains unclear.</p><p><strong>Methods: </strong>We retrospectively reviewed adult patients with IIH at a single center (2016-2023) who underwent ICPm within 9 months of an LP without intervening therapies affecting ICP. Continuous ICPm recordings were analyzed across postures and tilt angles and compared with LP opening pressures using Spearman correlation, Bland-Altman analysis, and categorical concordance of normal, high-, and low-pressure classifications.</p><p><strong>Results: </strong>Eighty-one patients met inclusion criteria (mean age 38.1 ± 11.8 years, 87.7% female, mean body mass index 34.7 ± 8.8 kg/m2). LP identified elevated pressure in 32 (39.5%) patients, while m categorized 10 (12.3%) as high, 18 (22.2%) as low, 8 (9.9%) as mixed, and 45 (55.6%) as normal. LP and ICPm values demonstrated only moderate correlation (ρ = 0.37-0.51, P ≤ .014) with a consistent negative bias, as LP pressures were 10 to 27 mm Hg higher than observed for ICPm. Discordance was notable in patients with low or mixed ICP profiles, in whom LP frequently yielded normal or elevated readings.</p><p><strong>Conclusion: </strong>LP and continuous ICPm are not interchangeable, as LP systematically overestimates parenchymal ICP and fails to capture postural and circadian variability. While LP remains useful for initial diagnosis, continuous ICPm provides a more comprehensive physiological assessment and may better guide management in IIH patients with persistent or ambiguous symptoms.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147841030","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":"Reinsertion Versus Replacement for Contaminated or Postoperatively Infected Bone Flaps: Findings From the Largest Individual-Patient Analysis to Date.","authors":"Asfand Baig Mirza, Pak Yin Lam, Sara Ahmad, Tony Harshan Linton-Jude, Soniya Chauhan, Wajiha Rauf, Feras Fayez, Ariadni Georgiannakis, Amisha Vastani, Gordan Grahovac, Varinder Singh Alg, Taofiq Desmond Sanusi, Babak Arvin, Ahmed-Ramadan Sadek, Jose Pedro Lavrador","doi":"10.1227/neu.0000000000004060","DOIUrl":"https://doi.org/10.1227/neu.0000000000004060","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bone flap infection and contamination are feared complications of cranial surgery, yet optimal management remains controversial. The aim of this review was to determine comparative outcomes of preservation with decontamination and reinsertion vs discard and replacement after intraoperatively contaminated or postoperatively infected bone flaps.</p><p><strong>Methods: </strong>We systematically reviewed 70 studies (621 patients) reporting either intraoperatively contaminated or postoperatively infected flaps (PROSPERO: CRD420251041697). Patient demographics, decontamination protocols, replacement materials, and outcomes were extracted and synthesized.</p><p><strong>Results: </strong>Three studies (49 patients) reported intraoperative contamination from dropped flaps, whereas 67 studies (572 patients) reported postoperative flap infections. Decontamination methods involved washing, scrubbing, and soaking with saline, povidone-iodine, peroxide or an antibiotic/antiseptic agent, and/or autoclaving, while replacement materials included titanium, polymethyl methacrylate, polyether ether ketone, or hydroxyapatite. Most patients achieved satisfactory cosmetic and neurological outcomes, with comparably low complication rates. None of the intraoperatively contaminated flaps developed postoperative infections after either approach. Preserved flaps carried significantly higher reoperation risk (absolute risk ratio 6.68%, odds ratio 2.948, 95% CI 1.450-5.993, P = .006). This means for every 15 patients treated with decontamination rather than replacement, one extra reoperation occurs. All reoperations occurred in patients with postoperatively infected flaps, most commonly because of severe recurrent infection. Comorbidities, for example, radiotherapy, immunosuppression, diabetes, and high body mass index, also emerged as a significant predictor of reoperation risk in logistic regression analysis (adjusted odds ratio 44.2, 95% CI 1.17-436, P = .0012).</p><p><strong>Conclusion: </strong>This is the largest pooled individual-patient data synthesis to date on management of contaminated or infected bone flaps. Both decontamination and replacement provide good outcomes and are safe and effective for intraoperatively contaminated flaps. However, decontamination with reinsertion carries higher reoperation risk compared with flap replacement among patients with postoperatively infected flaps. Flap preservation should therefore be undertaken selectively considering organism virulence, presence of purulence, and comorbidities. These results inform development of standardized risk-stratified guidelines and cost-effectiveness evaluation for bone flap management in cranial surgery.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818203","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: Reinsertion vs Replacement for Contaminated or Postoperatively-Infected Bone Flaps: Findings From the Largest Individual-Patient Analysis to Date.","authors":"Luca Bertola, Connor Rupp, Brandon Lucke-Wold","doi":"10.1227/neu.0000000000004078","DOIUrl":"https://doi.org/10.1227/neu.0000000000004078","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818020","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 Foramen Magnum and Foramen of Magendie Dredging Versus Posterior Fossa Decompression With Duraplasty in Adults With Chiari I Malformation-Syringomyelia: A Propensity-Matched Study.","authors":"Chenghua Yuan, Fan Yuan, Kang Li, Chenyuan Ding, Yueqi Du, Lei Zhang, Can Zhang, Zhenlei Liu, Kai Wang, Wanru Duan, Zuowei Wang, Xingwen Wang, Hao Wu, Zan Chen, Fengzeng Jian, Jian Guan","doi":"10.1227/neu.0000000000004061","DOIUrl":"https://doi.org/10.1227/neu.0000000000004061","url":null,"abstract":"<p><strong>Background and objectives: </strong>While neurosurgical posterior fossa decompression with duraplasty (PFDD) may provide clinical and radiological improvement for Chiari malformation-I (CM-I)-syringomyelia, the comparative efficacy and safety of PFDD without vs with intradural tonsillar manipulation (posterior fossa decompression with tonsil resection) has remained controversial for over 5 decades.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of 1231 CM-I-syringomyelia patients treated at our institution from 2003 to 2024, comparing 2 techniques: standard PFDD and foramen magnum and foramen of magendie dredging (FMMD, a modified posterior fossa decompression with tonsil resection procedure). Propensity score matching was used to balance baseline characteristics between the 2 groups. The primary outcomes were syrinx regression >50%, while secondary outcomes encompassed symptom-related parameters, syrinx regression, complication-related parameters, and reoperation rate.</p><p><strong>Results: </strong>A total of 1231 patients with CM-I were included, of whom 310 (25.2%) were in the PFDD group, and 921 (74.8%) were in the FMMD group. Per treatment analysis demonstrated no increase in odds of complications for FMMD (P > .05). PFDD was noninferior to FMMD in clinical improvement and syrinx regression (P = .147, P = .169, respectively). Syrinx regression (>50% reduction) was superior following FMMD (78% vs 60%, P < .001). PFDD had a higher rate of revision surgery than FMMD (15.5% vs 4.1%, log-rank P < .001).</p><p><strong>Conclusion: </strong>At our center, FMMD demonstrated greater effectiveness in managing syringomyelia, with higher rates of syrinx regression (>50% reduction), a lower rate of revision surgery, and no increase in complications compared with PFDD. Nonetheless, PFDD was similar to FMMD regarding clinical improvement and syrinx regression.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147818170","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 Surgical Ventricular Entry on Survival Outcomes in IDH-Mutant Gliomas.","authors":"Neslihan Nisa Gecici, Ahmed Habib, Jan Drappatz, Megan Mantica, Kalil G Abdullah, Sameer Agnihotri, Pascal O Zinn","doi":"10.1227/neu.0000000000003744","DOIUrl":"10.1227/neu.0000000000003744","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although some studies suggest ventricular entry (VE) is associated with complications and poor survival in glioblastoma, it remains unclear whether this association applies to isocitrate dehydrogenase (IDH)-mutant gliomas. This study evaluated the impact of VE on progression-free survival (PFS) and overall survival (OS) in these tumors.</p><p><strong>Methods: </strong>A retrospective analysis of patients with supratentorial IDH-mutant gliomas, treated between 2006 and 2021 at the University of Pittsburgh Medical Center was performed. VE was identified through postoperative imaging review.</p><p><strong>Results: </strong>A total of 231 patients were identified, with VE occurring in 32.9% (n = 76) of patients. During the study period, 64.9% of patients experienced disease progression, and 42.4% died. VE was associated with a higher rate of subependymal/ependymal enhancement (18.4% vs 3.2%, P < .001), leptomeningeal disease (6.6% vs 0.6%, P = .02) and, new distant foci development (18.4% vs 5.8% P = .006), shorter median OS ( P [log-rank] <0.0001), and shorter median PFS ( P < .0001). Multivariable analysis identified VE as an independent risk factor of decreased OS (HR: 2.1 [1.24-3.48], P = .005) and PFS (HR: 1.66 [1.13-2.44], P = .01), after adjusting for clinical, lesional, molecular factors, and subventricular zone contact.</p><p><strong>Conclusion: </strong>This study indicates that VE is associated with poor survival outcomes in IDH-mutant gliomas. These findings warrant prospective studies to better understand the risks, benefits, and mitigation strategies of VE in glioma surgery. Understanding the ependymal physical barrier as well as, cellular biological effects of VE, and its role in glioma tumorigenesis may serve as a basis for potential therapeutic targets in the future management of these patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1022-1031"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081309","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":"Stereotactic Radiosurgery for Cluster Headache: A Single Center Retrospective Study.","authors":"David Mathieu, Andréanne Hamel, Louis Carrier, Christian Iorio-Morin","doi":"10.1227/neu.0000000000003725","DOIUrl":"10.1227/neu.0000000000003725","url":null,"abstract":"<p><strong>Background and objectives: </strong>Trigeminal autonomic cephalalgias are rare primary headache disorders. Cluster headache (CH) is the most common form. Stereotactic radiosurgery (SRS) is sometimes used in medically refractory cases. This study was designed to evaluate the efficacy of SRS for the management of CH, with specific goals to assess the duration of pain relief, the recurrence rate, and the occurrence of sensory complications.</p><p><strong>Methods: </strong>A retrospective study of patients who underwent SRS at our institution for CH between 2004 and 2022 was conducted. Baseline demographics, symptoms, and pain characteristics were collected before treatment. Symptoms, pain evolution, and complications were obtained at follow-up. Outcomes were analyzed using the Kaplan-Meier method and descriptive statistics.</p><p><strong>Results: </strong>The cohort included 18 patients. One patient had bilateral pain and was treated sequentially on both sides. Both trigeminal nerve and sphenopalatine ganglion were targeted using a median maximum dose of 80 Gy. SRS yielded adequate pain control (modified Barrow Neurological Institute IIIb or better) in 79% of cases after a median of 4 months. Pain recurred after a median of 27 months in 80% of patients who had initial relief. Repeat SRS for recurrence was effective in 4 of 5 patients. New bothersome facial numbness (Barrow Neurological Institute III or worse) occurred in 16% after primary SRS and 50% after repeat SRS.</p><p><strong>Conclusion: </strong>SRS is a reasonable management option for refractory CH. Most patients will see at least transient improvement in pain attacks, but recurrence is common. Rates of bothersome numbness appear lower than previously reported after a single SRS procedure for CH.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1032-1039"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033647","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}