Neurosurgery最新文献

{"title":"Technical Feasibility of Quantitative Susceptibility Mapping Radiomics for Predicting Deep Brain Stimulation Outcomes in Parkinson Disease.","authors":"Alexandra G Roberts, Jinwei Zhang, Ceren Tozlu, Dominick Romano, Sema Akkus, Heejong Kim, Mert R Sabuncu, Pascal Spincemaille, Jianqi Li, Yi Wang, Xi Wu, Brian H Kopell","doi":"10.1227/neu.0000000000003721","DOIUrl":"10.1227/neu.0000000000003721","url":null,"abstract":"<p><strong>Background and objectives: </strong>Parkinson disease (PD) patients with motor complications are often considered for deep brain stimulation (DBS) surgery. Predicting symptom improvement to separate DBS responders and nonresponders remains an unmet need. Currently, DBS candidacy is evaluated using the levodopa challenge test (LCT) to confirm dopamine responsiveness and diagnosis. However, prediction of DBS success by measuring presurgical symptom improvement associated with levodopa dosage changes is highly problematic. Quantitative susceptibility mapping (QSM) is a recently developed MRI method that depicts brain iron distribution. As the substantia nigra and subthalamic nuclei are well visualized, QSM has been used in presurgical planning of DBS. Spatial features resulting from iron distribution in these nuclei have been previously linked with disease progression and motor symptom severity. Given its clear target depiction and prior findings regarding susceptibility and PD, this study demonstrates the technical feasibility of predicting DBS outcomes from presurgical QSM.</p><p><strong>Methods: </strong>A novel presurgical QSM radiomics approach using a regression model is presented to predict DBS outcome according to spatial features in QSM deep gray nuclei. To overcome limited and noisy training data, data augmentation using label noise injection or \"compensation\" was used to improve outcome prediction of the regression model. The QSM radiomics model was evaluated on 67 patients with PD who underwent DBS at 2 medical centers.</p><p><strong>Results: </strong>The QSM radiomics model predicted DBS improvement in the Unified Parkinson Disease Rating Scale at Center 1 and Center 2 with Pearson correlation , ( ) and , ( ), respectively. LCT failed to predict DBS improvement at Center 1 and Center 2 with Pearson correlation ( ) and ( ), respectively.</p><p><strong>Conclusion: </strong>QSM radiomics has potential to accurately predict DBS outcome in treating patients with PD, offering a valuable alternative to the time-consuming and low-accuracy LCT.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1139-1148"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health-Related Quality-of-Life Outcomes in Surgical Patients With Sacral Tarlov Cysts: A 2-Year Prospective Study.","authors":"Frank Feigenbaum, Susan E Parks, Madelene P Martin, Debbie A West, Tanishu D Ross, Onesica P Coleman, Kristina M Kupanoff","doi":"10.1227/neu.0000000000003758","DOIUrl":"10.1227/neu.0000000000003758","url":null,"abstract":"<p><strong>Background and objectives: </strong>We describe our longitudinal experience with patients who underwent surgical treatment for Tarlov cysts. General and disease-specific validated outcome measures were used to assess health-related quality of life through 2 years postoperatively.</p><p><strong>Methods: </strong>Patients who underwent surgical treatment for sacral Tarlov cysts between 2008 and 2023 were included. Demographics and cyst characteristics were documented. End points were the disease-specific Tarlov Quality-of-Life Scale and general health-related quality-of-life measures including the Oswestry Disability Index, visual analog pain Scales, and Short-Form 36. Patients completed survey measures preoperatively and at 3, 6, 12, and 24 months after surgery.</p><p><strong>Results: </strong>Data were obtained from 417 patients with an average age of 52.5 ± 11.2 years, and 91.1% was female. Patients reported significant improvement in the Tarlov Cyst Quality of Life (3.2 ± 0.1 to 2.1 ± 0.1, P < .001), visual analog pain scales at rest (4.5 ± 0.1 to 2.3 ± 0.1, P < .001) and upon activity (5.7 ± 0.2 to 3.1 ± 0.1, P < .001), and the Oswestry Disability Index (45.5 ± 0.8 to 31.6 ± 1.0, P < .001). Patients also reported improvement on 7 of the 8 Short Form 36 scales: Physical Functioning, Physical Limitations, Bodily Pain, Vitality, Social Functioning, Emotional Limitations, and Mental Health ( P < .001 for all models). There was significant improvement from the 1 to 2 years for physical functioning ( P = .040) and social functioning ( P = .016). The median tolerated sitting time increased from 15 min preoperatively to 45 minutes at 2 years postoperatively.</p><p><strong>Conclusion: </strong>This study, to our knowledge, is the first to demonstrate significant improvement in patients surgically treated for Tarlov cysts using general and disease-specific health-related quality-of-life scales for 2 years after surgery. Our results suggest that patients may continue to improve for up to 2 years after surgery in some domains.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1156-1165"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086566","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: Comparison of Lattice Flow Diverter and Pipeline Embolization Device in Unruptured Intracranial Aneurysms: A Real-World, Propensity Score Matching Study.","authors":"Ignacio Mesina-Estarrón, Yaser Sánchez Gama, Niels Pacheco Barrios","doi":"10.1227/neu.0000000000003911","DOIUrl":"10.1227/neu.0000000000003911","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e55"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146053104","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: Impact of Extent of Resection on Survival in Brain Metastasis: An Analysis of 867 Patients.","authors":"Alexander F C Hulsbergen, Marike L D Broekman","doi":"10.1227/neu.0000000000003969","DOIUrl":"10.1227/neu.0000000000003969","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e61"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147308479","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: Neurological Surgery Manpower Training and Density in Islamic Republic of Iran: A Population Study.","authors":"Bizhan Aarabi, Seyed Mahmood Tabatabaei, Majid Reza Farrokhi, Hosseinali Khalili, Farideh Nejat, Fariborz Samini, Noori Akhtar-Danesh","doi":"10.1227/neu.0000000000003403","DOIUrl":"10.1227/neu.0000000000003403","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e58"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542663","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":"Incarceration Status is Associated With Rates of Operative Neurosurgical Intervention and Inpatient Mortality After Traumatic Brain Injury.","authors":"Vikas N Vattipally, Kathleen R Ran, Anant P Rajan, Jacob Jo, Jose I Suarez, Joseph V Sakran, Elliott R Haut, Judy Huang, Chetan Bettegowda, Tej D Azad","doi":"10.1227/neu.0000000000003746","DOIUrl":"10.1227/neu.0000000000003746","url":null,"abstract":"<p><strong>Background and objectives: </strong>Incarcerated individuals face well-established healthcare disparities, yet limited research has examined outcomes after traumatic brain injury (TBI). The aim of this study was to evaluate whether incarceration status is independently associated with inpatient mortality after TBI and to assess potential disparities in neurosurgical intervention.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the American College of Surgeons Trauma Quality Programs data set (2017-2022) to identify adult patients with TBI after blunt injury. Multivariable hierarchical logistic regression and propensity score matching (20:1) were used to examine associations between incarceration status and inpatient mortality. A secondary analysis evaluated associations with cranial surgery and external ventricular drain or intracranial pressure monitor placement.</p><p><strong>Results: </strong>Among 243 547 patients, 1740 (0.7%) were incarcerated. These patients were younger (median, 40 years vs 64 years; standardized mean difference = 0.95) and more likely to have experienced a struck-by mechanism of injury (41% vs 6.9%; standardized mean difference = 1.2). After matching, incarcerated patients had significantly higher adjusted odds of inpatient mortality (odds ratio [OR], 1.49; 95% CI, 1.12-1.99; P < .01). There was a significant interaction between incarceration status and patient age for inpatient mortality ( P < .01). Finally, incarcerated patients had lower odds of receiving cranial surgery (OR, 0.76; 95% CI, 0.60-0.97; P = .03) but similar odds of external ventricular drain or intracranial pressure monitor placement (OR, 1.11; 95% CI, 0.77-1.59; P = .57).</p><p><strong>Conclusion: </strong>Incarceration status was independently associated with increased inpatient mortality after TBI and reduced likelihood of operative neurosurgical intervention. These findings highlight critical disparities in neurosurgical care for incarcerated individuals with TBI, underscoring the need for policy and institutional reforms to ensure equitable treatment.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1103-1112"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081288","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: The Timing of Diskectomy as a Predictor of Outcomes in Patients With Lumbar Disk Herniation: A Cohort Study on Varying Durations of Preoperative Symptoms.","authors":"Jake LeClaire, Faizah Karim, Zachary A Sorrentino, Julie L Chan","doi":"10.1227/neu.0000000000003825","DOIUrl":"10.1227/neu.0000000000003825","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"98 5","pages":"e51-e52"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691159","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":"Acalvaria: First Surviving Case From Egypt-Case Report and Comprehensive Review of the Literature.","authors":"Ahmed Ragab AbdelSalam, Ezzat AbdelKhalek, Essam Eldein M AbdelKawy, Mourad A R Tadros, Mira Mamdouh Azmy, Amr Mostafa Elkatatny, Yasser Omar Riyad","doi":"10.1227/neu.0000000000003732","DOIUrl":"10.1227/neu.0000000000003732","url":null,"abstract":"<p><strong>Background and objectives: </strong>Acalvaria is an extremely rare congenital malformation characterized by the absence of calvarial bones, with preservation of the skull base, facial bones, and usually normal brain tissue. Most reported cases are fatal in the neonatal period. The aim of this report was to present the first surviving case from Egypt and provide a comprehensive review of the literature.</p><p><strong>Methods: </strong>A detailed clinical, radiological, and imaging evaluation of a full-term male infant diagnosed with acalvaria was conducted. A literature search was performed to identify and summarize previously reported cases worldwide.</p><p><strong>Results: </strong>The patient, now 3-month-old, demonstrates normal growth and neurological development despite the absence of calvarial bones and defective posterior cervical vertebral arches, with no neurological deficits. Imaging confirmed the diagnosis. The literature review highlights the rarity of survival in acalvaria cases.</p><p><strong>Conclusion: </strong>This report adds to the limited literature on acalvaria by demonstrating the possibility of survival and normal development. It underscores the importance of accurate diagnosis, counseling, and follow-up in such rare congenital anomalies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1013-1021"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081303","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":"Efficacy of Vancomycin Powder Prophylaxis in 987 Cranial Surgeries for Nonmalignant Pathology.","authors":"Wesley Shoap, Robert C Osorio, Armond Esmaili, Philip Theodosopoulos, Shawn L Hervey-Jumper, Ezequiel Goldschmidt","doi":"10.1227/neu.0000000000003692","DOIUrl":"10.1227/neu.0000000000003692","url":null,"abstract":"<p><strong>Background and objectives: </strong>The use of prophylactic subgaleal vancomycin powder for preventing surgical site infections (SSI) has gained traction among cranial surgeons. However, its broad application remains controversial as the studies supporting its use are skewed toward high infection risk pathologies and have significant limitations. This study aimed to evaluate the efficacy of vancomycin powder in reducing SSIs in a cohort of patients with nonmalignant cranial pathologies.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for 987 patients who underwent cranial surgeries for nonmalignant pathologies between July 2021 and June 2024 at a major academic center. Patients were divided into 2 groups: those who received prophylactic vancomycin powder (682 patients) and those who did not (305 patients). Data on demographics, comorbidities, procedure types, and SSI occurrences were collected.</p><p><strong>Results: </strong>Established infection risk characteristics were nonsignificantly different between groups. There was no significant SSI difference when comparing patients not receiving vancomycin vs those who received the antibiotic (0.3% vs 0.7%, P = .578). There were 6 infections in total, 3/6 (50%) occurred with atypical meningiomas, 2/6 (33%) occurred with schwannomas, and 1/6 (17%) occurred with an amoebic abscess. Supratentorial craniotomies (odds ratio 0.95, P = .810) and posterior fossa craniotomies (odds ratio 1.18, 0.545) were the most common procedures and were nonsignificantly different between the cohorts. Meningiomas represented the largest portion of pathologies and were equally represented in both groups.</p><p><strong>Conclusion: </strong>This study suggests that the routine use of prophylactic vancomycin powder in nonmalignant cranial surgeries may be unnecessary, given an overall low incidence and lack of significant difference in SSIs between groups. These findings advocate for a more tailored approach to antibiotic prophylaxis, weighing the potential benefits against the known risks.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1076-1084"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874349","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":"Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines for the Treatment of Adults With WHO Grade II Diffuse Glioma: Update.","authors":"D Ryan Ormond, Chaitra Badve, Navid Redjal, Daniel Orringer, Simon Lo, Mateo Ziu, Jeffrey J Olson","doi":"10.1227/neu.0000000000003912","DOIUrl":"10.1227/neu.0000000000003912","url":null,"abstract":"<p><strong>Background: </strong>The management of World Health Organization (WHO) grade II diffuse glioma is an important facet of all physicians involved in neuro-oncology.</p><p><strong>Objective: </strong>This is an update of the evidence-based guidelines for management of WHO grade II diffuse gliomas published by the Congress of Neurological Surgeons and American Association of Neurological Surgeons in 2015.</p><p><strong>Methods: </strong>The medical literature from January 1, 2013, through January 31, 2020, was searched to determine if information was available to update, modify, or create new recommendations related to imaging, surgical approaches, neuropathology and molecular markers, radiotherapy, chemotherapy, and management of tumor recurrence.</p><p><strong>Results: </strong>The writing group used the information from the updated literature search to formulate recommendations based on this evidence and not simply built on biased consensus or expert opinion.</p><p><strong>Conclusion: </strong>This series of guideline documents provides an update of the information and recommendations provided in the 2015 version. It sets a benchmark as to the published information we have to support the management of this difficult disease. It also provides clues to key investigations that are necessary to move us toward effective control of WHO grade II diffuse gliomas.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"98 5","pages":"984-991"},"PeriodicalIF":3.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691200","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}