Neurosurgery最新文献

{"title":"Letter: Arms Race Control Score Standardizes Residency Applicant Publication Assessment.","authors":"Sonia Pulido, Michael Adegoke, Mazin E Khalil, Umaru Barrie","doi":"10.1227/neu.0000000000003491","DOIUrl":"https://doi.org/10.1227/neu.0000000000003491","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991329","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":"In Reply: Arms Race Control Score Standardizes Residency Applicant Publication Assessment.","authors":"Michael M Covell, Michael Kogan, Elad I Levy, Christian A Bowers","doi":"10.1227/neu.0000000000003492","DOIUrl":"https://doi.org/10.1227/neu.0000000000003492","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020399","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":"A Comparison Between Proximal and Distal Cerebrospinal Fluid Sampling Sites in Patients With External Ventricular Drains.","authors":"Tom Deleu, Dominike Bruyninckx, Steffen Fieuws, Sofie Dietvorst, Christophe Oosterbos, Rik Demaerel, Frederic Van Havenbergh, Georges Versyck, Zoë Hunin, Jarne Schepens, Stephanie Wuyts, Michael Vanhoyland, Steven Smeijers, Fauve Poncelet, Siebe Orolé, Sara Smeets, Daphne Goossens, Willem Vandenhoudt, Pieter Vermeersch, Philippe De Vloo","doi":"10.1227/neu.0000000000003482","DOIUrl":"https://doi.org/10.1227/neu.0000000000003482","url":null,"abstract":"<p><strong>Background and objectives: </strong>Routine cerebrospinal fluid (CSF) sampling in patients with external ventricular drains (EVDs) is a standard neurosurgical practice to screen for infections and steer CSF diversion management. Although proximal CSF sampling (through CSF aspiration from the tubing) permits analysis of fresh intraventricular CSF, it carries a risk of iatrogenic infection, hemorrhage, and catheter blockage, contrary to distal CSF sampling (collected passively from the fluid chamber). This study assesses the agreement in CSF characteristics obtained through proximal and distal sampling in EVD patients.</p><p><strong>Methods: </strong>An open, prospective, monocentric study was conducted between January 2022 and December 2023. All patients undergoing EVD placement were eligible. CSF was sampled twice weekly until EVD removal as per routine institutional practice. Samples were obtained synchronically proximally and distally. The primary end point was the agreement between sampling methods of the white cell count as quantified using the intraclass correlation (ICC), the within SD, and mean absolute difference. Secondary end points were the intermethod agreement of lactate, glucose, total protein, and microbial culture and the evaluation of the agreement over time.</p><p><strong>Results: </strong>Sixty-one patients (2 × 197 samples) were analyzed. An ICC of 0.731 (95% CI: 0.650-0.796) was observed for white blood cell counts between proximal and distal samples. Microbial culture results showed perfect agreement. Strong ICCs were found for lactate (0.966), glucose (0.822), and total protein (0.910). These relations were maintained over time (>4 weeks). Although there were a relatively small number of infectious samples (n = 10), study strengths were the real-world setting, inclusion of all ages and etiologies, and longitudinal sampling over time.</p><p><strong>Conclusion: </strong>Distal CSF sampling is a reliable alternative to proximal CSF sampling, with a good ICC for white blood cell count; an excellent ICC for lactate, glucose, and protein; and a perfect ICC for culture, even in EVDs >4 weeks in place.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974084","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":"In Reply: Letter: Risk Factors Associated With Seizure After Treatment of Chronic Subdural Hemorrhage: A Systematic Review and Meta-Analysis.","authors":"Niels Pacheco-Barrios, Aryan Wadhwa, Tzak S Lau, Max Shutran, Christopher S Ogilvy","doi":"10.1227/neu.0000000000003489","DOIUrl":"https://doi.org/10.1227/neu.0000000000003489","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008755","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":"Dural Tenting in Elective Craniotomies: A Randomized Clinical Trial.","authors":"Lukasz Przepiorka, Katarzyna Wójtowicz, Sławomir Kujawski, Karol Wiśniewski, Ernest Jan Bobeff, Rafał Kruk, Bartłomiej Kulesza, Jan Fortuniak, Adam Mróz, Piotr Dunaj, Maciej Kaspera, Szymon Hoppe, Kamil Krystkiewicz, Katarzyna Kwiecień, Dariusz Szczepanek, Dariusz J Jaskólski, Piotr Ładziński, Radosław Rola, Jacek Furtak, Tomasz Trojanowski, Andrzej Marchel, Przemysław Kunert","doi":"10.1227/neu.0000000000003480","DOIUrl":"https://doi.org/10.1227/neu.0000000000003480","url":null,"abstract":"<p><strong>Background and objectives: </strong>Dural tenting sutures are a well-known neurosurgical technique. However, claims of them preventing extradural hematomas (EDHs) lack evidence-based support. For that reason, we decided to evaluate the noninferiority of routinely not tenting the dura in elective supratentorial craniotomies.</p><p><strong>Methods: </strong>A randomized, multicenter, investigator-blinded and participant-blinded, controlled interventional trial with 1:1 allocation. We included adults undergoing elective, supratentorial craniotomies. Not tenting the dura was an intervention, and the control group consisted of patients with at least 3 dural tenting sutures. The primary outcome was the risk of reoperation because of EDH, and secondary outcomes included a selection of clinically relevant outcomes.</p><p><strong>Results: </strong>We randomized 490 patients into intervention (238, 49%, not tenting the dura) and control (252, 51%, dural tenting) study groups, as per intention-to-treat analysis. Proportions of EDH surgeries in the intervention group were noninferior in comparison with the control group and not significantly different using the intention-to-treat (0.8% and 0.4%, P = .98), per-protocol (0.5%, 0.4%, P > .99), and as-treated (0.5%, 0.7%, P > .99) analyses. There were no significant differences in secondary outcomes: postoperative 30-day mortality (0.8%, 1.2%, P > .99), postoperative 30-day readmission (1.7%, 4.4%, P = .99), new neurological deficit or deterioration of a previous (19.7%, 15.5%, P = .81), cerebrospinal fluid leak (1.3%, 4.4%, P > .99), deterioration of postoperative headache over 5 numerical rating scale (4.4%, 2.4%, P = .85), epidural collection thickness over 3 mm (90.8%, 87.3%, P = .81), and midline shift over 5 mm (7.6%, 4.8%, P = .791) in the intervention and control study groups in intention-to-treat analysis. Similarly, secondary outcomes were not different in per-protocol and as-treated analyses. Other than cerebrospinal fluid leaks and EDHs, there were 17 adverse events in the intervention group and 19 in the control group (intention-to-treat analysis, 7.1% and 7.5%, respectively).</p><p><strong>Conclusion: </strong>This trial demonstrates the noninferiority of omitting prophylactic dural tenting for postoperative EDH requiring surgery in elective, supratentorial craniotomies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004763","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 Clinical and Radiographic Outcomes Between Percutaneous Endoscopic Transforaminal Diskectomy and Unilateral Biportal Endoscopic Diskectomy for the Treatment of L4/5-Level MSU Size-3 Lumbar Disk Herniation: A 2-Year Retrospective Cohort Study.","authors":"Rongkun Xu, Liang Wang, Xinyu Yang, Xing Chen, Wenyang Fu, Shangye Li, Xinzhi Zhang, Xinyu Liu, Lianlei Wang","doi":"10.1227/neu.0000000000003478","DOIUrl":"https://doi.org/10.1227/neu.0000000000003478","url":null,"abstract":"<p><strong>Background and objectives: </strong>Percutaneous endoscopic transforaminal diskectomy (PETD) and unilateral biportal endoscopic diskectomy (UBED) have demonstrated favorable clinical outcomes in managing lumbar disk herniation (LDH). The surgical treatment of Michigan State University (MSU) Size-3 LDH remains technically challenging. The aim of this study was to compare the clinical and radiographic outcomes of PETD and UBED, specifically in the treatment of L4/5-level MSU Size-3 LDH.</p><p><strong>Methods: </strong>The study included 138 patients who underwent either PETD (75 cases) or UBED (63 cases). During a follow-up period of at least 2 years, clinical outcomes were evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), modified MacNab criteria, complication and recurrence rates, serum creatine phosphokinase (CPK) levels, and other surgical data. Radiographic parameters, including intraoperative bone loss, paraspinal muscle-disk ratio, and intervertebral height index, were also monitored.</p><p><strong>Results: </strong>Both VAS scores for low back and leg pain, as well as ODI scores, showed significant decreases in both groups postoperatively. At baseline, 3 months postoperation, and at the final follow-up, VAS and ODI scores showed no statistically significant differences between the 2 groups. Compared with the UBED group, the PETD group showed lower VAS scores for incision pain on the first day and third day after surgery ( P < .001). Although no significant differences were observed in modified MacNab criteria, complication rates, or LDH recurrence, PETD demonstrated advantages in operative time, incision length, intraoperative blood loss, postoperative length of stay, total hospitalization costs, serum CPK levels, and intraoperative bone loss volume ( P < .001). No statistically significant differences were observed in the intervertebral height index or paraspinal muscle-disk ratio.</p><p><strong>Conclusion: </strong>Both PETD and UBED can achieve favorable clinical outcomes in the treatment of L4/5-level MSU Size-3 LDH. Compared with UBED, PETD performed under local anesthesia offers superior short-term postoperative incision pain relief, improved perioperative quality of life, and reduced surgical invasiveness.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008793","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: Risk Factors Associated With Seizure After Treatment of Chronic Subdural Hemorrhage: A Systematic Review and Meta-Analysis.","authors":"Aden Noronha, Ioan Valnarov-Boulter, Panithi Khusakul, Ciaran Scott Hill, Tim Michael Young","doi":"10.1227/neu.0000000000003486","DOIUrl":"https://doi.org/10.1227/neu.0000000000003486","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033903","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":"Association Between Operative Neurosurgical Intervention and Favorable Discharge Among Patients With Traumatic Subdural Hematoma and Poor Neurological Examination.","authors":"Tej D Azad, Vikas N Vattipally, Kathleen R Ran, Sriya M Vattipally, Maximilian Moody, Carlos A Aude, Jordina Rincon-Torroella, Risheng Xu, Elliott Haut, John R Williams, Christopher D Witiw, Debraj Mukherjee, Lucia Rivera-Lara, Susanne Muehlschlegel, Jose I Suarez, Judy Huang, Chetan Bettegowda, James P Byrne","doi":"10.1227/neu.0000000000003477","DOIUrl":"https://doi.org/10.1227/neu.0000000000003477","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patients with traumatic subdural hematoma (SDH) and poor neurological presentation frequently experience adverse outcomes. Few studies investigate whether operative neurosurgical intervention is associated with favorable outcomes for these patients. The objective of this study was to measure associations between operative neurosurgery and favorable discharge in patients with traumatic SDH and poor neurological presentation.</p><p><strong>Methods: </strong>This was a retrospective cohort study using the American College of Surgeons Trauma Quality Programs Dataset. In total, 13 393 adult patients (≥18 years) presenting with traumatic SDH, midline shift >5 mm, and Glasgow Coma Scale ≤8 were included. Risk-adjusted hierarchical regression models were specified to measure associations between operative neurosurgery and favorable discharge to home or inpatient rehabilitation. Effect modification by pupillary response (both [2R], one [1R] or neither reactive [0R]) was evaluated. Marginal effects of operative neurosurgery on favorable discharge probability were estimated across pupillary response and age subgroups.</p><p><strong>Results: </strong>Patients with 0R pupils were least likely to undergo operative neurosurgery (0R, 34% vs 1R, 50% vs 2R, 50%; P < .001). After risk adjustment, operative neurosurgery was associated with favorable discharge (odds ratio, 1.93; 95% CI, 1.74-2.14). This association was significantly modified by pupillary response (P for interaction, <0.001), with the greatest potential benefit observed for patients with 0R pupils (probability, 3.7% increased to 11.8%). Operative neurosurgery provided potential benefit across all age quartiles but declined significantly for the eldest patients (>75 years).</p><p><strong>Conclusion: </strong>Operative neurosurgical intervention is associated with favorable discharge among patients with traumatic SDH and poor neurological presentation. This was consistent across pupillary response and age subgroups, but potential benefit was reduced among the eldest patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026107","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":"Factors Associated With a Higher 30-Day Hospitalization Period for Pituitary Adenoma Patients: Introducing a Novel Outcome Metric.","authors":"Anthony Tang, Hussein M Abdallah, Paul A Gardner, Georgios A Zenonos, Yue-Fang Chang, Garret Choby, Eric W Wang, Carl H Snyderman","doi":"10.1227/neu.0000000000003471","DOIUrl":"https://doi.org/10.1227/neu.0000000000003471","url":null,"abstract":"<p><strong>Background and objectives: </strong>A novel metric that incorporates both length of stay (LOS) and readmission in 1 metric, the 30-day hospitalization ratio (HR) (total number of days of hospitalization/30 days) was applied to patients undergoing endonasal surgery for pituitary adenoma. The objectives of this study were to determine predictive factors associated with prolonged hospitalization and economic burden and to demonstrate the utility of 30-day HR as a novel outcome metric compared with LOS and readmission.</p><p><strong>Methods: </strong>A retrospective chart review of 492 patients who underwent an endoscopic endonasal approach for pituitary adenoma at a Pituitary Tumor Center of Excellence between January 2015 and September 2022. The main outcome measures analyzed were LOS, readmission, and HR.</p><p><strong>Results: </strong>Patients had an average age of 55.4 ± 16.5 years; there were slightly more male patients (53.8%), and patients were predominantly White (82.5%). 49.2% of patients were employed, 6.2% were unemployed, 23.7% were retired, 5.3% were disabled, and 15.6% had unknown employment status. Intraoperative lumbar drain (LD) placement (P = .003, 95% CI 1.77-16.39) and low preoperative prealbumin (P = .01, 95% CI 1.17-7.33) were associated with readmission. Nonemployed status (P = .004, β 2.93) and intraoperative LD placement (P < .001, β 0.31) were associated with an increase in log LOS. Nonemployed status (P < .001, β 0.18), intraoperative LD placement (P < .001, β 0.33), and low preoperative prealbumin (P = .04, β 0.14) were associated with a higher log HR. No nasoseptal flap reconstruction use was associated with decreased log LOS and log HR (P = .002, β -0.16; P = .009, β -0.14).</p><p><strong>Conclusion: </strong>Hospitalization ratio is a noninferior metric to LOS and readmission and has the potential to provide a more complete quantification of outcomes and capture the impact of future hospital interventions.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020430","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":"Integrated Clinical Genetic Analysis of Meningiomas Causing Bony Hyperostosis Shows More Severe Clinical Course and Overexpression of Secreted Pro-osteogenic Factors.","authors":"Malcolm F McDonald, A Basit Khan, Andrew Chang, Collin English, Eric A Goethe, Ishan A Patel, Sricharan Gopakumar, Trevor Trudeau, Vijay Nitturi, Sean Lau, Elizabeth Ledbetter, Diego Rojas, Arif Harmanci, Akdes S Harmanci, Tiemo J Klisch, Akash J Patel","doi":"10.1227/neu.0000000000003465","DOIUrl":"https://doi.org/10.1227/neu.0000000000003465","url":null,"abstract":"<p><strong>Background and objectives: </strong>Meningiomas are the most common primary tumor of the brain and may elicit hyperostosis of the adjacent bone. Whether hyperostosis is related to reactive changes of the overlying bone or by invasion of the tumor itself is unclear. In this article, we characterize the clinical and molecular differences of meningiomas with hyperostosis from those without hyperostosis.</p><p><strong>Methods: </strong>One hundred and eighty-one primary, nonsyndromic, nonradiation-induced meningiomas with DNA and RNA sequencing were included in a retrospective study. Preoperative MRI and computed tomography scans were reviewed by a fellowship-trained neuroradiologist to identify the presence of hyperostosis or bone invasion. Clinical, radiographic, and surgical data were gathered for each patient. Bulk RNA sequencing was performed, and data were analyzed for gene set enrichment analysis, gene ontologies, and differentially expressed genes along with chromosomal deletions and canonical mutations.</p><p><strong>Results: </strong>Sixty-six (36.5%) meningiomas had radiographic evidence of hyperostosis compared with 115 (63.5%) without hyperostosis. Patients with hyperostosis had more severe presentation with increased rates of emergency department admissions (P = .0320) and seizure presentation (P = .0480). Hyperostotic tumors preferentially manifested in the olfactory groove location (P = .004). Radiographically, tumors with hyperostosis had higher rates of edema (P = .0280), midline shift (P = .010), nonhomogeneous enhancement (P = .001), T2 hyperechoic signal (P = .001), and bone invasion (P < .001). Patients with hyperostosis had increased estimated blood loss intraoperatively (P = .006), longer time in the operating room (P = .045), and higher rates of craniectomy and cranioplasty (P < .001 and P = .001). Fifty-five percent of all upregulated differentially expressed genes in hyperostotic tumors are secreted, and many are related to skeletal system development (BMP3, RBP4, MATN4, CILP2, and FGF7).</p><p><strong>Conclusion: </strong>In a retrospective study, meningiomas with hyperostosis are region-specific, are related to higher intraoperative complications, and present with distinct radiographic features. Transcriptional analysis revealed upregulation of secreted proteins that positively influence bone development and growth.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033898","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}