Neurosurgery最新文献

{"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}

{"title":"The Role of Stereotactic Radiosurgery in Patients With Foramen Magnum Meningiomas.","authors":"Zhishuo Wei, Ajay Niranjan, Mishika Mehta, Suchet Taori, Khushi Rai, Hansen Deng, Constantinos G Hadjipanayis, L Dade Lunsford","doi":"10.1227/neu.0000000000003625","DOIUrl":"https://doi.org/10.1227/neu.0000000000003625","url":null,"abstract":"<p><strong>Background and objectives: </strong>Management options for foramen magnum meningiomas (FMM) include observation, attempts at surgical resection, and radiation therapy. The authors report the single-institution long-term experience of the use of primary or adjuvant stereotactic radiosurgery (SRS) for FMMs.</p><p><strong>Methods: </strong>A total of 40 FMM patients (29 female) underwent SRS between 1987 and 2022. The median age at SRS was 62.0 (range: 30-82) years. Ten patients had prior surgical resection (2 gross total resections, 8 subtotal resections), whereas 4 patients had prior fractionated radiation therapy. Tumors were located at the anterior midline (5 patients), anterior lateral (25 patients), posterior midline (5 patients), and posterior lateral (5 patients) quadrants. The median prescription dose was 12.5 Gy (range: 10-16), and the median cumulative FMM tumor volume treated was 2.3 cc (range: 0.35-12.0).</p><p><strong>Results: </strong>The median follow-up time was 88.0 months (range: 12-253). Fourteen patients had a follow-up >5 years, and 12 additional patients had >10-year follow-ups. Complete imaging response was noted in 1 patient, partial regression was noted in 13 patients, and 25 patients had no further growth. One patient had tumor progression 9 months after initial SRS and then underwent repeat surgical resection. The overall local tumor control rate was 98%. A total of 35 patients had improved or stable neurological symptoms after SRS, and 5 patients reported delayed worsening of symptoms. Ten patients were deceased at the last clinical follow-up. The median overall survival was 102 months (range: 41-164). None of the patients died related to central nervous system disease progression. No post-SRS adverse radiation effects were detected.</p><p><strong>Conclusion: </strong>Progressive FMM presents a management challenge. In this experience, SRS effectively prevented local tumor progression and preserved neurological function. Our experience supports the role of SRS as a primary or adjuvant management strategy.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608881","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: Clinical Characteristics and Outcomes of Traumatic Brain Injury in a High-Volume Tertiary Care Center in India: A Prospective Observational Cohort Study.","authors":"Moritz Steinruecke, Peter J Hutchinson, Angelos Kolias, Mathew Joseph","doi":"10.1227/neu.0000000000003642","DOIUrl":"https://doi.org/10.1227/neu.0000000000003642","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608879","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: Clinical Characteristics and Outcomes of Traumatic Brain Injury in a High-Volume Tertiary Care Center in India: A Prospective Observational Cohort Study.","authors":"Natarajan Muthukumar","doi":"10.1227/neu.0000000000003643","DOIUrl":"https://doi.org/10.1227/neu.0000000000003643","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608880","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: Detailed Analysis of Late Adverse Effects of Stereotactic Radiosurgery for Dural Arteriovenous Fistulas.","authors":"Tushar Kanti Bhadra, Brandon Lucke-Wold","doi":"10.1227/neu.0000000000003627","DOIUrl":"https://doi.org/10.1227/neu.0000000000003627","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608877","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}