Neurosurgery最新文献

{"title":"Gait and Balance After MRI-Guided High-Intensity Focused Ultrasound Thalamotomy for Treatment of Tremor.","authors":"Rohit Prem Kumar, Ilona Cazorla-Morales, Samantha Adwani, Elma A Chowdhury, Geoffrey R O'Malley, Francis Ruzicka, Nicholas D Cassimatis, Elana Clar, Robert R Goodman, Gregory Westgate, Challiz Punla, Themba Nyirenda, Hooman Azmi","doi":"10.1227/neu.0000000000003745","DOIUrl":"10.1227/neu.0000000000003745","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although magnetic resonance imaging guided focused ultrasound (MRgFUS) thalamotomy has shown a robust safety and efficacy profile for tremor treatment, gait disturbances have been reported but often lack objective measurement. The aim of this study was to evaluate gait and balance outcomes in patients with essential tremor (ET)-only and tremor-dominant Parkinson's disease with or without ET (TDPD ± ET) who have undergone MRgFUS thalamotomy for treatment of their tremors, using validated, multidimensional measures.</p><p><strong>Methods: </strong>This retrospective review included all consecutive patients who underwent MRgFUS thalamotomy between June 14, 2021, and February 1, 2023. Patients who did not have a preprocedure or postprocedure gait and balance evaluation, and those lost to follow-up, were excluded. Primary outcomes were changes in the preprocedural and postprocedural Tinetti gait and balance scores and timed up and go time at the 3-month visit. Additional outcomes included changes in ambulation time, steps taken to walk 30 feet, and clinical improvement.</p><p><strong>Results: </strong>Of 92 total patients (72 ET-only, 20 TDPD ± ET), the ET-only cohort had a median follow-up of 94 days (IQR 91-113), and the TDPD ± ET cohort had a follow-up of 99.5 days (IQR 92.25-119.00). In ET-only patients, significant improvements were observed in median Tinetti balance (pre 15 [IQR 12-16] vs post 15 [IQR 13-16], P = .031) and median 30-ft ambulation time (8.11 seconds [IQR 6.74-10.77] vs 8.06 seconds [IQR 6.21-10.23], P = .009), with no change in median Tinetti gait, Tinetti total scores, timed up and go time, or steps to ambulate 30-ft. In patients with TDPD ± ET, only the median Tinetti gait improved (9.00 [IQR 6.00-11.00] vs 9.50 [IQR 7.75-12.00], P = .004).</p><p><strong>Conclusion: </strong>MRgFUS thalamotomy is associated with a low risk of gait/balance disturbances and may also improve these functions in patients with ET and TDPD ± ET. This supports MRgFUS as a viable treatment option.</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":"145207094","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":"Abstract Awards for the 2025 Congress of Neurological Surgeons Annual Meeting.","authors":"","doi":"10.1227/neu.0000000000003723","DOIUrl":"https://doi.org/10.1227/neu.0000000000003723","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 4","pages":"988-990"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207096","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":"Neurosurgery Practice: A Journal Comes of Age.","authors":"Douglas Kondziolka","doi":"10.1227/neu.0000000000003712","DOIUrl":"https://doi.org/10.1227/neu.0000000000003712","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 4","pages":"765"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207108","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":"Connections.","authors":"Douglas Kondziolka","doi":"10.1227/neu.0000000000003560","DOIUrl":"https://doi.org/10.1227/neu.0000000000003560","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":"97 4","pages":"763-764"},"PeriodicalIF":3.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207040","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: Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Target Therapy: A Single-Center Experience.","authors":"Shamsudheen Cholayil, Vangipuram Harshil Sai, Vangipuram Shankar","doi":"10.1227/neu.0000000000003795","DOIUrl":"https://doi.org/10.1227/neu.0000000000003795","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192231","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: Blood Pressure Targets After Aneurysmal Subarachnoid Hemorrhage: Is Lower Better?","authors":"Catherine Veilleux, Matthew E Eagles, Jay Riva-Cambrin, R Loch Macdonald","doi":"10.1227/neu.0000000000003794","DOIUrl":"https://doi.org/10.1227/neu.0000000000003794","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192156","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: Stereotactic Radiosurgery Dose Reduction for Melanoma Brain Metastases Patients on Immunotherapy or Targeted Therapy: A Single-Center Experience.","authors":"Salem M Tos, Georgios Mantziaris, Jason P Sheehan","doi":"10.1227/neu.0000000000003796","DOIUrl":"https://doi.org/10.1227/neu.0000000000003796","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192134","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: Blood Pressure Targets After Aneurysmal Subarachnoid Hemorrhage: Is Lower Better?","authors":"Maximiliano A Hawkes, Giuseppe Lanzino, Alejandro A Rabinstein","doi":"10.1227/neu.0000000000003793","DOIUrl":"https://doi.org/10.1227/neu.0000000000003793","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192168","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":"Primary Versus Salvage Stereotactic Radiosurgery for Patients With Olfactory Groove Meningiomas: A 35-Year Single-Institution Experience.","authors":"Chris Z Wei, Regan M Shanahan, Sydney Scanlon, Kenan Kerem Ozcinar, Vanshika Lohia, Hansen Deng, Constantinos G Hadjipanayis, L Dade Lunsford, Ajay Niranjan","doi":"10.1227/neu.0000000000003759","DOIUrl":"https://doi.org/10.1227/neu.0000000000003759","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) is an important management strategy for patients with olfactory groove meningiomas (OGMs). This study aimed to compare outcomes after primary SRS vs salvage SRS postresection in our institution over the past 35 years.</p><p><strong>Methods: </strong>We reviewed the radiographic imaging of 2030 patients with meningiomas who underwent SRS between 1987 and 2022. Seventy-nine patients with OGM were identified. The median patient age at SRS was 62 years (range, 33-90 years). Forty-eight patients (60.76%) underwent primary SRS and 31 patients (39.24%) had previous resections. The median tumor volume was 4.30 cc (range, 0.19-26.90 cc), and the median margin dose prescribed at SRS was 13 Gy (range, 9-18 Gy). SRS protocol, neurological outcomes, overall survival, and local tumor control (LTC) were evaluated.</p><p><strong>Results: </strong>The overall survival for all OGM patients was 17 years (range, 0.8-24.3 years). No patient deaths were related to intracranial tumor progression. Among primary SRS in 48 patients, 4 (8.33%) had tumor progression at a median time of 9.2 years (range, 0.4-12.3 years). For patients who underwent salvage SRS, 7 patients (22.5%) had delayed tumor progression at a median time of 6.4 years (range, 0.4-15.2 years) after SRS. Previous resection was found to be associated with anosmia (P < .01) and decreased LTC (P = .024). After primary SRS, 73% of patients experienced symptom improvement change. After salvage SRS 23 % of patients showed clinical improvement. In patients with peritumoral edema at SRS, the median percentage edema volume reduction was 82% after SRS.</p><p><strong>Conclusion: </strong>SRS provided low risk long-term tumor control in OGM patients. Primary SRS provided superior LTC and preservation or improvement of olfactory function in most patients.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186353","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":"Deep 16S rDNA Sequencing of Chronic Subdural Hematomas Suggests Involvement of Bacterial Infection in Recurrences.","authors":"Johanna Mohr, Anne Albers, Frieder Schaumburg, Werner Paulus, Benjamin Brokinkel, Walter Stummer, Dorothee Cäcilia Spille, Christian Thomas","doi":"10.1227/neu.0000000000003754","DOIUrl":"https://doi.org/10.1227/neu.0000000000003754","url":null,"abstract":"<p><strong>Background and objectives: </strong>Chronic subdural hematoma (CSDH) is an encapsulated blood collection between the dura mater and arachnoid that often follows mild head trauma. It involves pronounced inflammation and angiogenesis, and recurrence remains common despite advances in surgical management. Subclinical bacterial involvement has been hypothesized as a potential factor in these recurrent cases. We aimed to determine whether bacteria are present in CSDH outer membranes and to define accompanying histological and transcriptomic changes.</p><p><strong>Methods: </strong>A total of 39 Formalin-fixed paraffin-embedded outer-capsule specimens from 19 patients (17 primary, 22 recurrent) underwent: (1) ultra-deep Nanopore 16S rDNA profiling; (2) histomorphology with Gram staining, lipopolysaccharide immunohistochemistry and quantitative immune-cell counts; and (3) RNA-seq of 3 matched primary-recurrent pairs, followed by differential-expression and pathway analysis.</p><p><strong>Results: </strong>Gram staining revealed bacteria in 2 recurrent samples (5%) from a single patient, whereas lipopolysaccharide immunohistochemistry was negative in all cases. Notably, 16S rDNA sequencing detected bacterial DNA exclusively in recurrent lesions (6 samples from 4 patients), with none in primary cases (P = .02, χ2 test). The identified bacterial genera included Staphylococcus, Neisseria, Prevotellamassilia, and Paracoccus. Histopathological evaluation showed no significant differences in eosinophils, myeloperoxidase-positive cells, CD3-positive T-cells, or CD20- positive B-cells when comparing primary with recurrent lesions, or infected to uninfected membranes. Unsupervised clustering of matched primary and recurrent CSDH samples revealed distinct transcriptomic profiles, identifying 184 differentially expressed genes (including consistent Toll-like receptor 4 upregulation) and highlighting pathways related to development, protein biosynthesis, and wound healing.</p><p><strong>Conclusion: </strong>These findings suggest that bacterial DNA is present in a subset of recurrent CSDH, suggesting that bacteria could be involved in recurrences. Further research with larger cohorts is needed to determine whether antimicrobial or anti-inflammatory strategies might help reduce recurrence.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186402","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}