Neurosurgery最新文献

{"title":"A Scoping Review of Focused Ultrasound- Blood-Brain Barrier Opening for Treatment of Chronic Pain.","authors":"Erica Gillespie, Elise Bouchal, Trish Elliott, Julie G Pilitsis","doi":"10.1227/neu.0000000000003595","DOIUrl":"https://doi.org/10.1227/neu.0000000000003595","url":null,"abstract":"<p><p>The blood-brain barrier (BBB) presents a major challenge in administering pharmacological therapy for neurological disorders such as chronic pain. Focused ultrasound (FUS)-mediated BBB opening (BBBO) presents an alternative means of drug delivery. We examine potential candidate drugs and particle technology for use in FUS-mediated BBBO for treatment of pain. In this scoping review, we searched Pubmed and Embase databases for articles discussing FUS and pain. Using the Rayyan platform, we identified 705 articles and 376 were identified for abstract review, ultimately resulting in text review of 95. This scoping review was designed to address the following: (1) What are the limitations of chronic pain treatments in BBB penetration? and (2) What advancements in particles are likely to be used in FUS and BBBO for chronic pain? Despite interest in FUS-mediated BBBO for drug delivery in central nervous system disorders, no human studies have been conducted to assess its efficacy for the treatment of chronic pain. Preclinical work shows that many receptor agonists/antagonists reduce allodynia and hyperalgesia when administered directly to the brain, but not peripherally. Recent advances in particle and FUS technology allows precise targeting of specific brain regions and may hinder efflux and degradation of compounds at target. In combination with advancements in particle and FUS technology, drugs for treatment of chronic pain have been successful in preclinical models. Care must be chosen for selecting parameters, drugs, and particles for initial clinical studies to move the field forward successfully.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649913","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":"Sex-Related Differences in Functional and Neurological Outcomes of Spinal Cord Injury.","authors":"Braeden Benedict, Saad Javeed, Muhammad Kaleem, Justin K Zhang, Salim Yakdan, Kathleen Botterbush, Huacong Wen, Yuying Chen, Allan Belzberg, Sami Tuffaha, Stephen Shelby Burks, Allan D Levi, Eric L Zager, Amir H Faraji, Mark A Mahan, Rajiv Midha, Thomas J Wilson, Neringa Juknis, Jacob K Greenberg, Wilson Z Ray","doi":"10.1227/neu.0000000000003615","DOIUrl":"https://doi.org/10.1227/neu.0000000000003615","url":null,"abstract":"<p><strong>Background and objectives: </strong>Traumatic spinal cord injury (SCI) tends to occur in different demographics and with differing etiology between males and females. Sex-related differences may influence recovery, but there remains a lack of evidence on this subject. Our objective was to quantify the influence of sex on functional and neurological outcomes of SCI.</p><p><strong>Methods: </strong>This was a retrospective cohort study of the multicenter, prospectively maintained SCI Model Systems database from 1992 to 2016. Traumatic SCI patients (≥15 years old) enrolled in a participating inpatient rehabilitation center within 30 days of injury with follow-up at 1 year were included. The primary outcome was the Functional Independence Measure (FIM), which quantifies independence in 13 activities of daily living. Secondary outcomes were individual FIM items, American Spinal Injury Association (ASIA) Motor Index Score at 1 year postinjury, and improvement in ASIA Impairment Scale (AIS). The impact of sex on each outcome was evaluated using propensity score-weighted multivariable regression analyses while controlling for covariates such as age, injury severity, and baseline function.</p><p><strong>Results: </strong>The analysis included 3924 patients (20% female). Multivariable linear regression showed that female sex was associated with worse FIM scores at 1 year postinjury (B = -3.1, 95% CI: -4.4 to -1.8). The FIM items with the greatest differences in independence between males and females were bladder management and transfers, which favored males. For ASIA Motor Score, while females had 10-point greater absolute scores at 1 year (P = .03) and 2-point greater improvement (P = .03) compared with males, no effect was present after adjusting for confounding variables in multivariable regression. The rate of ASIA Impairment Scale improvement was higher in females (P = .04), but this was not significant in multivariable regression (odds-ratio: 1.25, 95% CI: 0.96-1.63).</p><p><strong>Conclusion: </strong>Male sex is associated with greater functional independence, despite equal or greater motor recovery in female patients. Female SCI patients may benefit from targeted interventions to improve independence.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649919","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":"Evaluating the Impact of Frailty on Mortality in Patients With Nonoperative and Operative Type II Odontoid Fracture: An American College of Surgeons Trauma Quality Improvement Program Survival Analysis of 22 440 Patients.","authors":"Evan N Courville, Oluwafemi P Owodunni, Meic H Schmidt, Cameron S Crandall, Tatsuya Norii, Christian A Bowers","doi":"10.1227/neu.0000000000003622","DOIUrl":"https://doi.org/10.1227/neu.0000000000003622","url":null,"abstract":"<p><strong>Background and objectives: </strong>Type II odontoid fractures (T2OF) are the most prevalent cervical spine injuries among the elderly. Nonetheless, there are insufficient data regarding the influence of frailty on outcomes for both nonoperative and operative treatment approaches. We sought to evaluate the influence of frailty on outcomes using 5-factor modified frailty index.</p><p><strong>Methods: </strong>We performed a retrospective review of the American College of Surgeons Trauma Quality Improvement Program database from 2015 to 2020. We analyzed nonoperative and operative traumatic T2OF cases. Outcomes included major complications, hospital length of stay (LOS), nonhome discharge (NHD), mortality rates, and survival probabilities. We used unmatched and propensity score-matched risk-adjusted models to assess the association between frailty and all outcomes. Survival probabilities were examined using Kaplan-Meier plots, stratified by frailty strata.</p><p><strong>Results: </strong>A total of 22 440 patients comprising 7138 (31.8%) robust, 7913 (35.2%) normal, 5158 (22.9%) frail, and 2231 (9.9%) very frail patients were included. Results from unmatched multivariable analyses revealed a dose-dependent relationship between frailty and all outcomes, in both cohorts (P < .05). Propensity score-matched resulted in 3942 nonoperative and operative matched pairs. Preoperative characteristics were similar between cohorts, except for age: 75 years (IQR: 60-83) for nonoperative and 70 years (IQR: 56-78) for operative, and male sex: 1799 (55.8%) for nonoperative and 439 (61.1%) for operative cohorts. Significant mortality reductions (43%-77%; P < .05) were observed in the operative cohort compared with the nonoperative cohort across all frailty strata. As expected, the operative cohort had longer LOS and increased NHD risk ranging from 64% to 97%, P < .001. In Kaplan-Meier analyses, survival declined significantly across increasing frailty strata P < .001.</p><p><strong>Conclusion: </strong>Increasing frailty was independently associated with major complications, LOS, NHD, and decreased survival. Operative patients exhibited improved survival compared with nonoperative patients across all frailty strata. These findings highlight the importance of frailty in T2OF management and care coordination.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649915","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: Evaluating the Impact of Frailty on Mortality in Nonoperative and Operative Type II Odontoid Fracture Patients: An ACS-TQIP Survival Analysis of 22440 Patients.","authors":"Anna F Fusco, Julie L Chan","doi":"10.1227/neu.0000000000003632","DOIUrl":"https://doi.org/10.1227/neu.0000000000003632","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649914","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":"Hypertrophic Olivary Degeneration in Brainstem Cavernous Malformations: An Analysis of Predictors and Clinical Implications.","authors":"Delal Bektas, Giuseppe Lanzino, Stephen Graepel, Kelly D Flemming","doi":"10.1227/neu.0000000000003631","DOIUrl":"https://doi.org/10.1227/neu.0000000000003631","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study aimed to evaluate predictors of hypertrophic olivary degeneration (HOD) in patients with brainstem cerebral cavernous malformations (CCMs) and to examine its association with functional outcomes.</p><p><strong>Methods: </strong>A cohort of 120 patients with brainstem CCM was analyzed using prospectively collected registry data and retrospective chart reviews. Demographic, clinical, radiological, and surgical data were evaluated. Predictors of HOD and poor functional outcomes were identified through univariate and multivariate analyses.</p><p><strong>Results: </strong>The cohort included 54 females (45.0%), with a mean age at diagnosis of 43.8 years (SD = 16.5). Symptomatic hemorrhage was present in 70.8% of patients at diagnosis, and 28.3% underwent surgical intervention. Radiographic HOD was observed in 20% of patients (n = 24), with 87% of cases involving lesions within the Guillain-Mollaret triangle (GMT). Larger lesion size (odds ratio [OR] = 1.09, 95% CI: 1.01-1.19, P = .027), pontine location (OR = 19.81, P = .006), and GMT involvement (OR = 25.24, P < .001) were significantly associated with HOD. Repeated symptomatic hemorrhage and surgery, including the extent of resection, did not predict the development of HOD. Patients with HOD had worse functional outcomes at last follow-up (P = .012), with GMT involvement remaining the sole independent predictor of mRS ≥3 (OR = 3.44, P = .040).</p><p><strong>Conclusion: </strong>HOD reflects trans-synaptic degeneration within the GMT and is strongly associated with lesion location and size. It serves as a radiological marker of cumulative damage to the brainstem. Preoperative imaging and risk stratification focusing on GMT involvement are critical for guiding management and counseling patients with brainstem CCM.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649916","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":"Interhospital Variation in Operative Intervention for Firearm-Related Penetrating Traumatic Brain Injury and Associations With Inpatient Mortality.","authors":"Vikas N Vattipally, Kathleen R Ran, Saket Myneni, Jiaqi Liu, Jacob Jo, Debraj Mukherjee, Jose I Suarez, Elliott R Haut, Joseph V Sakran, Judy Huang, Chetan Bettegowda, James P Byrne, Tej D Azad","doi":"10.1227/neu.0000000000003623","DOIUrl":"https://doi.org/10.1227/neu.0000000000003623","url":null,"abstract":"<p><strong>Background and objectives: </strong>Firearm-related penetrating traumatic brain injury (pTBI) carries a high mortality risk and grim prognosis. This study aimed to quantify interhospital variation in operative intervention for this patient population and assess whether cranial surgery tendency is associated with inpatient mortality.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program (TQIP) data set to identify adult patients presenting with firearm-related pTBI. Risk-adjusted hierarchical regression evaluated associations with cranial surgery. Hospitals were stratified into quartiles based on surgical tendency (lowest, quartile 1; highest, quartile 4 [Q4]). Propensity score matching was performed across quartiles, and a multivariable regression model was constructed to investigate associations between hospital quartile and inpatient mortality. Effect modification by pupillary reactivity was tested.</p><p><strong>Results: </strong>Cranial surgery rates for 4895 patients (median age, 31 years) varied widely across 309 hospitals (0%-71%; median, 21%; median odds ratio, 1.33). After matching, treatment at Q4 hospitals was associated with significantly reduced odds of mortality compared with treatment at quartile 1 hospitals (odds ratio, 0.61; 95% CI, 0.47-0.78). Patients presenting with one (interaction P = .03) or both (interaction P = .03) unreactive pupils experienced amplified survival benefits from treatment at Q4 hospitals.</p><p><strong>Conclusion: </strong>Substantial interhospital variation exists in operative intervention for firearm-related pTBI. Hospitals with higher surgical tendency were associated with improved survival, and this effect was amplified for patients presenting with unreactive pupils. These findings suggest a need to standardize operative decision-making for patients with firearm-related pTBI, aligning with ongoing efforts by organizations such as the Brain Trauma Foundation.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649917","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: Predictors of Hydrocephalus Risk After Stereotactic Radiosurgery for Vestibular Schwannomas: Utility of the Evans Index.","authors":"Cezmi Çağrı Türk, Nurettin Durmuş, Gülsüm Akar, Furkan Yürürdurmaz","doi":"10.1227/neu.0000000000003646","DOIUrl":"https://doi.org/10.1227/neu.0000000000003646","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649918","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":"1025 Bridging the Gap: Mission: BRAIN Foundation's Global Efforts to Enhance Neuroscientific Education Opportunities and Global Healthcare Equity: Erratum.","authors":"Juan Pablo Navarro-Garcia de Llano, Paola Suarez-Meade, Adrian Safa, Emiliano Sanchez-Garavito, Aparna Nair-Kanneganti, Will Aarsheim, George Jallo, Theodore H Schwartz, Kingsley O Abode-Iyamah, Oluwaseun O Akinduro, Rodrigo Ramos-Zúñiga, Arturo Ayala Arcipreste, Shahaan Razak, Julia B Duvall, Kee B Park, Brian Nahed, Taimur Hassan, Juan Carlos Gutierrez, Timothy Joseph Nyanzi, Ludovicco Orbechi, Saumya Joshi, Michael T Lawton, April Sabangan, Alfredo Quinones-Hinojosa","doi":"10.1227/neu.0000000000003673","DOIUrl":"https://doi.org/10.1227/neu.0000000000003673","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642962","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: Nighttime Treatment of Ruptured Intracranial Aneurysms are Associated With Poor Outcomes: Corrigendum.","authors":"Yu Chang, Pang-Shuo Perng, Chih-Yuan Huang","doi":"10.1227/neu.0000000000003675","DOIUrl":"https://doi.org/10.1227/neu.0000000000003675","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642963","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: Performance of ChatGPT and GPT-4 on Neurosurgery Written Board Examinations.","authors":"Ben Pobiel, Birra Taha, Anant Naik","doi":"10.1227/neu.0000000000003634","DOIUrl":"https://doi.org/10.1227/neu.0000000000003634","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144637658","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}