Neurosurgery最新文献

{"title":"Comparison of Lattice Flow Diverter and Pipeline Embolization Device in Unruptured Intracranial Aneurysms: A Real-World, Propensity Score Matching Study.","authors":"Li Bao, Yiran Lu, Shuang He, Yunfeng Zhang","doi":"10.1227/neu.0000000000003788","DOIUrl":"https://doi.org/10.1227/neu.0000000000003788","url":null,"abstract":"<p><strong>Background and objectives: </strong>Flow diverters (FDs) have been increasingly used in treating unruptured intracranial aneurysms (UIAs). However, comparative studies between the novel lattice flow diverter (LFD) and other FDs are limited. Our study aimed to compare outcomes of LFD and the pipeline embolization device (PED) for UIAs using propensity score matching (PSM).</p><p><strong>Methods: </strong>Patients with UIAs treated with LFD or PED between August 2023 and November 2024 were included. PSM was performed to adjust for age, sex, comorbidities, ischemic stroke history, smoking status, alcohol abuse, preoperative modified Rankin Scale scores, history of multiple aneurysms, aneurysm characteristics, adjunctive coiling, and angiographic follow-up duration. Perioperative complications and clinical and angiographic outcomes were compared after matching.</p><p><strong>Results: </strong>A total of 99 patients treated by LFD and 187 patients treated by PED were included. Compared with the PED group, the LFD group had fewer females and more patients with a history of multiple aneurysms, wider aneurysm necks, shorter stent lengths, and lower rates of in-stent stenosis (ISS) (stenosis > 50%). After PSM, 55 matched pairs were analyzed. The LFD group demonstrated significantly lower ISS rates (1.8% vs 14.5%, P = .037), with no significant differences in perioperative complications, the complete occlusion rate at the median 216-day angiographic follow-up (87.3% vs 85.5%, P > .999), or favorable outcomes (96.4% vs 94.5%, P > .999) compared with the PED group.</p><p><strong>Conclusion: </strong>The mechanical balloon-based LFD with surface modification showed a lower ISS rate and comparable perioperative outcomes, short-term occlusion rates, and clinical prognosis compared with PED. The advantages brought by the Innovation of LFD warrant further validation through long-term randomized controlled trials.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239465","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":"Patient Variability Drives Postoperative Outcome Volatility More Than Surgeon or Indication: A Bayesian Simulation Study of PROMIS Global Health for Lumbar Spinal Stenosis.","authors":"Seth M Meade, Michael Shost, Arpan A Patel, Daniel T Lilly, Brittany Lapin, Michael P Steinmetz, Thomas Mroz, Ghaith Habboub","doi":"10.1227/neu.0000000000003777","DOIUrl":"https://doi.org/10.1227/neu.0000000000003777","url":null,"abstract":"<p><strong>Background and objectives: </strong>Patient-reported outcome measures (PROMs) are ubiquitously used to assess surgical success after surgery for lumbar spinal stenosis (LSS); however, variability of PROMs can limit their utility as stand-alone outcomes. This study aimed to quantify the extent of PROM volatility after surgery for LSS and the relative contributions of patient and surgeon heterogeneity to that volatility.</p><p><strong>Methods: </strong>Patients undergoing surgery for LSS between 2015 and 2023 with completed Patient-Reported Outcome Measurement Information System Global Health physical summary scores (PROMIS-PH) were retrospectively queried from a large prospectively collected institutional database. PROM volatility was measured by reversal fluctuations greater than the minimally clinically important difference in PROMIS-PH (5+ T-score points), deemed \"reversal of surgical effects\" (RSEs), over time with respect to patient's preoperative baseline (B-RSEs), and sequential postoperative values (S-RSEs). Bayesian simulation modeling quantified the relative contribution of patient (i.e., intrinsic factors such as demographics and psychological distress) and surgeon (i.e., extrinsic factors such as surgeon experience) variability on outcome volatility.</p><p><strong>Results: </strong>Of 2439 included patients, 40% and 58% of patients experienced at least 1 B-RSEs and S-RSE, respectively, in the 2-year postoperative period, with peak incidence between 6 and 12 months postoperatively. Increased patient-level variability was associated with better peak postoperative PROMIS-PH. Patient-level outcome variability was significantly more responsible than surgeon-level variability for total outcome volatility (SD = 4.20 [95%CI: 4.03, 4.38] vs SD = 2.44 [95%CI: 1.78-3.20]). Eliminating variability attributed to surgeon did not significantly change postoperative outcome volatility for PROMIS-PH. Reducing patient variability did significantly reduce postoperative outcome volatility for PROMIS-PH.</p><p><strong>Conclusion: </strong>PROMs are most volatile during the first postoperative year after surgery for LSS. Patient-level variability is predictive of better peak PROM scores postoperatively. Reducing patient, but not surgeon variability, reduced overall postoperative outcome volatility.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239473","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":"Complications of Cerebral Venous Thrombosis After Cerebellopontine Angle Tumor Resection: A STROBE Retrospective Observational Cohort Study.","authors":"Mathieu Lozouet, Charles Maquet, Julien Horion, Elisabeth Garrido, Octavian Mihai Sirbu, Jean-Paul Marie, Stéphane Derrey","doi":"10.1227/neu.0000000000003761","DOIUrl":"https://doi.org/10.1227/neu.0000000000003761","url":null,"abstract":"<p><strong>Background and objectives: </strong>Postoperative cerebral venous thrombosis (pCVST) after skull base surgery remain a controversial topic in the literature, particularly considering their incidence, clinical course, association with postoperative complications, and potential need for anticoagulant therapy in the postoperative period.</p><p><strong>Methods: </strong>We conducted a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) retrospective observational study including all patients who underwent surgery for a cerebellopontine angle tumor between 2010 and 2023, with available postoperative imaging suitable for evaluating pCVST. Patients with cerebellar metastases were excluded. pCVSTs were categorized into 2 subgroups: severe venous stenosis and authentic thrombosis, based on imaging findings. A minimum follow-up of 12 months was required. The primary end point was the occurrence of postoperative complications, defined as death, hemorrhagic events, or cerebrospinal fluid leakage.</p><p><strong>Results: </strong>A total of 158 patients were included, primarily with vestibular schwannomas (75%) and meningiomas (21%). pCVST was identified in 73 patients (46.2%), including 33 with severe stenosis and 40 with authentic thrombosis. Thrombosis was significantly associated with several surgical factors, such as sinus injury, venous compression, prolonged operative time, and transpetrous approaches. None of the patients newly received postoperative anticoagulant therapy in our study. Recanalization occurred in only 15.6% of cases with authentic thrombosis. Multivariate analysis showed no significant association between postoperative complications and the presence of thrombosis. However, the association with cerebrospinal fluid leakage approached significance in univariate analysis (P = .07).</p><p><strong>Conclusion: </strong>Postoperative venous thrombosis is not an uncommon finding after cerebellopontine angle tumor surgery. Our results do not support a significant association with major postoperative complications nor evidence to support the routine use of anticoagulation, given the potential for hemorrhagic complications and the uncertain therapeutic benefit.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239447","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":"Functional Outcome After Initial and Multiple Intracerebral Hemorrhage in Patients With a Brainstem Cavernous Malformation: An International Multicenter Collaboration.","authors":"Christoph Wipplinger, Alejandro N Santos, David J Park, Yusuke S Hori, Laurèl Rauschenbach, Thiemo Florin Dinger, Adrian Engel, Yan Li, Guilherme Santos Piedade, Charbel Moussalem, Börge Schmidt, Tamara M Wipplinger, Adrian M Siegel, Giuseppe Lanzino, Bernard R Bendok, Steven D Chang, Kelly D Flemming, Ramazan Jabbarli, Karsten Wrede, Ulrich Sure, Philipp Dammann","doi":"10.1227/neu.0000000000003773","DOIUrl":"https://doi.org/10.1227/neu.0000000000003773","url":null,"abstract":"<p><strong>Background and objectives: </strong>Brainstem cavernous malformations (BSCM) can result in spontaneous intracerebral hemorrhage (ICH), often resulting in significant morbidity. We aimed to assess the functional outcome and identify predictors of functional neurological outcome after single and multiple symptomatic hemorrhages.</p><p><strong>Methods: </strong>As part of an international multicenter collaboration, institutional databases from 3 different tertiary referral centers included BSCM patients with complete baseline characteristics, MRI Data set, ≥1 ICH, and ≥1 follow-up examination followed at our institutions between 2003 and 2023. Functional neurological outcome was obtained using the modified Rankin Scale at diagnosis, before and after each ICH, and last follow-up. Patients were excluded after surgical removal of the lesion and/or loss of follow-up.</p><p><strong>Results: </strong>A total of 383 patients (41.47 ± 15.51 age; 220 [57.4%] female) were included and followed for an average of 63.16 ± 85.75 months. Functional neurological outcome deteriorated in 47.2% (P = .010) after the second ICH and in 46.5% (P = .007) after the third ICH. Moreover, the functional neurological status was impaired in 22.3% (P < .001) of patients at last available follow-up compared with the time of BSCM diagnosis.</p><p><strong>Conclusion: </strong>In our study, we observed that the chance of full recovery might decrease with each ICH. We observed a significantly associated neurological deterioration after each ICH compared with initial ICH.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207118","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 Low-Intensity Ultrasound on Pediatric Dural Cells: Implications for Calvarial Repair.","authors":"Hanna J Anderson, David S Hersh, Yusuf Khan","doi":"10.1227/neu.0000000000003787","DOIUrl":"https://doi.org/10.1227/neu.0000000000003787","url":null,"abstract":"<p><strong>Background and objectives: </strong>Pediatric patients frequently exhibit delayed bone flap resorption after autologous cranioplasty. The dura has been shown to be mechanosensitive and has been implicated in cranial regeneration, but an improved understanding of the mechanisms underlying this relationship may yield new strategies for reducing resorption after cranioplasty. Our objective was to examine the role of dural cells in cranial regeneration by investigating the presence of potential stem cell populations and their capacity for osteogenic differentiation, as well as the response of dural cells to mechanical stimulation by low-intensity ultrasound-derived acoustic radiation forces.</p><p><strong>Methods: </strong>Rat-derived dural cells were isolated from 4 to 6-week-old Sprague Dawley rats and treated with low-intensity ultrasound administered at 150 mW/cm2 for 20 minutes/d. Flow cytometry was used to investigate stem cell surface marker expression with or without ultrasound. Dural cells were also maintained in osteogenic media and assessed for markers of osteogenic differentiation. RNA-seq analysis was then performed to examine the effect of ultrasound treatment on the global mRNA expression of dural cells.</p><p><strong>Results: </strong>Over 90% of dural cells expressed cell surface markers consistent with a stem cell population and were maintained after 28 days of culture, both with and without ultrasound treatment. Dural cells cultured in osteogenic media, however, demonstrated increased proliferation, decreased osteocalcin expression, and no evidence of mineralization. RNA-seq analysis demonstrated upregulation of genes related to cellular movement, cellular assembly and organization, and cell-cell signaling after ultrasound treatment. Both canonical and noncanonical Wnt signaling were upregulated, but downstream effectors of noncanonical Wnt signaling were downregulated.</p><p><strong>Conclusion: </strong>Dural cells express characteristic stem cell markers but do not undergo osteogenic differentiation after chemical or mechanical stimulation; however, ultrasound treatment upregulates elements of the Wnt paracrine signaling pathway, suggesting a novel mechanism that might be harnessed to improve outcomes after autologous cranioplasty.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207047","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":"Long-Term Nervus Intermedius Function Outcomes and Their Predictors in Patients With Vestibular Schwannoma After Microsurgery.","authors":"Haoming Geng, Yuanchen Tang, Binghan Zhang, Xiaolong Wu, Yiqiang Zhou, Gang Song, Jiantao Liang","doi":"10.1227/neu.0000000000003774","DOIUrl":"https://doi.org/10.1227/neu.0000000000003774","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this retrospective study was to identify predictors of long-term dysfunction of the nervus intermedius (NI) after vestibular schwannoma (VS) surgery.</p><p><strong>Methods: </strong>A follow-up questionnaire was administered to patients who underwent VS resection by the retrosigmoid approach between December 2018 and May 2024. All patients were followed for at least 6 months after surgery, and a total of 439 patients were included in the final analysis. Clinical data, including tumor size, surgical outcomes, and postoperative facial nerve (FN) and hearing function, were retrospectively reviewed. Univariate and multivariate logistic regression analyses were performed to determine predictors of long-term NI dysfunction.</p><p><strong>Results: </strong>Among the 439 patients, 216 (49.2%) reported long-term NI dysfunction, including 98 (22.3%) with taste dysfunction, 184 (41.9%) with eye dryness, and 66 (15.0%) with both symptoms. NI dysfunction was significantly associated with maximum tumor diameter (P < .001), extent of resection (P = .005), FN function at discharge (P < .001), and hearing outcomes (P = .002). Multivariate analysis identified poor FN function at discharge and unserviceable hearing as independent predictors of long-term NI dysfunction. For taste dysfunction, cystic tumor (P = .016) and poor FN function at discharge (P = .020) were significant, with both factors emerging as independent predictors. For eye dryness, significant variables included tumor size (P = .008), FN function at discharge (P < .001), and hearing outcomes (P = .023), although only poor FN function was independently predictive.</p><p><strong>Conclusion: </strong>Long-term NI dysfunction is a common and under-recognized complication after VS surgery. Poor FN function and unserviceable hearing at discharge independently predict NI dysfunction. In addition, cystic tumor type and poor FN function predict taste dysfunction, whereas poor FN function alone predicts eye dryness. These factors may aid in prognostication and guide surgical planning and postoperative counseling.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Long-Term Nervus Intermedius Function Outcomes and Their Predictors in Patients With Vestibular Schwannoma After Microsurgery.","authors":"Vikram C Prabhu, John T Tsiang, Amy L Pittman, Anand V Germanwala, Matthew L Kircher, Douglas E Anderson, John P Leonetti","doi":"10.1227/neu.0000000000003784","DOIUrl":"https://doi.org/10.1227/neu.0000000000003784","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207055","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":"Geographic Disparities in Neurosurgery Workforce Adequacy Across the United States: Projections to 2037.","authors":"Jason Silvestre, Joseph M Abbatematteo, Sydney Seeger, Charles A Reitman, Michael T Lawton","doi":"10.1227/neu.0000000000003762","DOIUrl":"https://doi.org/10.1227/neu.0000000000003762","url":null,"abstract":"<p><strong>Background and objectives: </strong>Studies on the adequacy of the neurosurgery workforce have been limited. The objectives of this study were to assess the supply, demand, and adequacy of the neurosurgery workforce in the United States.</p><p><strong>Methods: </strong>This was a cross-sectional study of US neurosurgeons using data from the Health Workforce Simulation Model. Supply was defined as the number of full-time neurosurgeons working in the United States. Demand was defined as the number of full-time neurosurgeons needed to meet healthcare needs under status quo and improved access scenarios. Workforce adequacy was defined as the ratio of supply and demand. Linear regression was used to analyze workforce trends.</p><p><strong>Results: </strong>From 2025 to 2037, the supply of neurosurgeons was projected to increase from 7030 to 7230 (2.8% increase, P < .001). Over the same period, demand was projected to increase under status quo (7310 to 8310, 13.7% increase, P < .001) and improved access (10 210 to 11 830, 15.9% increase, P < .001) scenarios. Accordingly, neurosurgery workforce adequacy was projected to decrease under status quo (96.2% to 87.0%, P < .001) and improved access (68.9% to 61.1%, P < .001) scenarios. In 2025, neurosurgery workforce adequacy was lower in nonmetropolitan areas compared with metropolitan areas under the status quo (30.8% vs 101%, P < .001) and improved access (10.7% vs 78.8%, P < .001) scenarios. In 2025, the states with the lowest neurosurgery workforce adequacy were Nevada (42.9%), New Jersey (66.7%), and Indiana (73.3%). By 2037, the states with the lowest projected neurological surgery workforce adequacy were Delaware (33.3%), Nevada (37.5%), New Hampshire (50.0%), and Vermont (50.0%).</p><p><strong>Conclusion: </strong>Projected inadequacies exist for the neurosurgery workforce, which are greatest in nonmetropolitan areas and certain US states. Future research is needed to develop strategies that improve neurosurgery workforce adequacy including training opportunities to increase the supply of future neurosurgeons.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207112","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":"Quantifying the Importance of Upper Cervical Extension Reserve in Adult Cervical Deformity Surgery and Its Impact on Baseline Presentation and Outcomes: Erratum.","authors":"Peter G Passias, Jamshaid M Mir, Andrew J Schoenfeld, Anthony Yung, Justin S Smith, Virginie Lafage, Renaud Lafage, Bassel Diebo, Alan H Daniels, Breton G Line, Robert K Eastlack, Gregory M Mundis, Khaled M Kebaish, Jeffrey P Mullin, Richard G Fessler, Praveen V Mummaneni, Dean Chou, David Kojo Hamilton, Sang Hun Lee, Alex Soroceanu, Justin K Scheer, Themistocles Protopsaltis, Han Jo Kim, Thomas J Buell, Richard A Hostin, Munish C Gupta, Eric O Klineberg, K Daniel Riew, Douglas C Burton, Frank J Schwab, Shay Bess, Christopher I Shaffrey, Christopher P Ames","doi":"10.1227/neu.0000000000003819","DOIUrl":"https://doi.org/10.1227/neu.0000000000003819","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207110","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":"Corticosteroid Use Before Stereotactic Brain Biopsy for Suspected Lymphoma.","authors":"Maged T Ghoche, Kenji Miki, Skyler Oken, Namya Manoj, Neslihan Nisa Gecici, Ahmed Habib, Jan Drappatz, Megan Mantica, Pascal Zinn, Kalil G Abdullah","doi":"10.1227/neu.0000000000003778","DOIUrl":"https://doi.org/10.1227/neu.0000000000003778","url":null,"abstract":"<p><strong>Background and objectives: </strong>Primary central nervous system lymphoma (PCNSL) is a rare, aggressive lymphoma requiring histopathological confirmation for diagnosis. Stereotactic brain biopsy (SBB) is the gold standard for definitive diagnosis, but preoperative corticosteroid therapy (CST), commonly administered to manage symptoms, may induce cytoreduction and obscure diagnostic features. Previous studies offer conflicting evidence on whether CST compromises diagnostic yield. This study assesses the impact of preoperative CST on the diagnostic yield of SBB in PCNSL, evaluating steroid timing, dose, duration, and associated postoperative complications.</p><p><strong>Methods: </strong>We retrospectively reviewed 725 patients who underwent SBB between 2014 and 2025 to identify 104 patients with pathologically confirmed PCNSL. Patients were categorized based on CST exposure and stratified by timing, cumulative dose, and duration of therapy. Clinical, radiological, and pathological variables were analyzed. Statistical tests included χ2, Welch t-test, and Fisher exact test.</p><p><strong>Results: </strong>The overall diagnostic yield was 92.3%. Among patients who received CST (n = 43), the diagnostic yield was 95.3% (95% CI: 84.2%-99.4%), compared with 90.2% (95% CI: 79.8%-96.3%) in the non-CST group (P = .46). Yield remained high across intervals between CST administration and biopsy (<48 hours: 96.4%; 48-72 hours: 91.7%; >72 hours: 100%; P = .658), cumulative dose (≤20 mg: 95.5% [95% CI: 78.2%-99.2%], 21-40 mg: 100% [95% CI: 70.1%-100%], >40 mg: 100% [95% CI: 70.1%-100%]; P = 1.0), and duration (≤5 days: 94.6% [95% CI: 81.8%-99.3%] vs >5 days: 100% [95% CI: 91.8%-100%]; P = 1.0). Postoperative complications occurred in 4.8% of cases, with no significant difference by CST status.</p><p><strong>Conclusion: </strong>Preoperative corticosteroids do not significantly reduce diagnostic accuracy in PCNSL in our cohort. These findings support the safe use of CST for symptom control in suspected PCNSL with expeditious biopsy. Optimizing biopsy timing, technique, and coordination among disciplines remains essential to ensure diagnostic success.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207042","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}