Neurosurgery最新文献

{"title":"Reoperation Risk Factors for Cranioplasty Surgery.","authors":"Karim Hafazalla, Angeleah Carreras, Jean Filo, Shiv Patil, Vanessa Guzylak, Arbaz Momin, Pious Patel, Dwight Mitchell Self, Michael Reid Gooch, James Harrop, Jack Jallo","doi":"10.1227/neu.0000000000003976","DOIUrl":"10.1227/neu.0000000000003976","url":null,"abstract":"<p><strong>Background and objectives: </strong>Adverse events after cranioplasty remain a significant burden in postsurgical care, often necessitating reoperations. Identifying predictors of reoperation could optimize care. We investigated reoperation after cranioplasty and factors that correlate.</p><p><strong>Methods: </strong>A retrospective analysis of 318 cranioplasty patients at our single institution was conducted. Clinical demographics, preoperative and perioperative parameters, and postoperative outcomes of patients were collected from electronic health records. Univariable and multivariable logistic regression were conducted to identify significant predictors of reoperation after cranioplasty. Patients who had previous cranioplasties or the bone flap replaced during the craniectomy were excluded.</p><p><strong>Results: </strong>Of 318 cranioplasty patients, 62 (19.4%) required reoperation. These patients had shorter time intervals between craniectomy and cranioplasty relative to patients who did not require reoperation (median of 86 vs 140 days, IQR: 31-164 and 79-211, P ≤ .01). The reoperation group also had a greater frequency of cranioplasties done during their index hemicraniectomy hospital stay (21.3% vs 10.9%, P = .03), longer time interval to restarting antiplatelets or anticoagulants (median of 34 vs 11 days, IQR 18-102 and 7-16, P = .03), greater number of preoperative ventriculoperitoneal shunt patients (26.2% vs 12.9%, P = .01), and lower utilization of autologous bone implant (62.3% vs 80.0%, P ≤ .01). On multivariable analysis, use of autologous bone implant (odds ratio: 0.38 [0.15-0.94], P = .03) and postoperative subgaleal drain use (odds ratio: 0.35 [0.13-0.91], P = .03) were associated with a lower odds of reoperation, while greater fluid collection on postoperative computed tomography was linked to a higher odds of reoperation (odds ratio: 1.05 [1.01-1.11], P = .02).</p><p><strong>Conclusion: </strong>Autologous bone implant, postoperative subgaleal drain use, and fluid collection on postoperative computed tomography are independent predictors of reoperations after cranioplasty. Further assessment of these factors may be beneficial for predictive modeling and surgical management of patients requiring cranioplasty.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1203-1210"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147308411","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":"Device and Procedure for Closed-Loop Endovascular Vagus Nerve Stimulation and Evoked Response Sensing.","authors":"Varun Kashyap, Zachary Sanger, Mark Ashby, Scott Stanslaski, Kevin Nguyen, Ashok Nageswaran, Robert Olson, Dale Seeley, Heather Huna, Alan Shi, Erik Fahimi, Phillip Falkner, Alexander A Khalessi","doi":"10.1227/neu.0000000000003958","DOIUrl":"10.1227/neu.0000000000003958","url":null,"abstract":"<p><strong>Background and objectives: </strong>Vagus nerve stimulation (VNS) is a United States Food and Drug Administration-approved treatment for refractory epilepsy, stroke rehabilitation, chronic or recurrent depression as adjunctive therapy, and rheumatoid arthritis. It is also being explored as a potential treatment modality for heart failure and relapsing-remitting multiple sclerosis among other disease states. The current mode of stimulation delivery employed widely is the use of nerve cuffs mounted directly on the nerve via an invasive cervical cutdown procedure. Furthermore, the feedback from the nerve upon stimulation delivery is not monitored. It has also been reported that the internal fascicular organization along the vagus nerve is highly variable and therefore different groups of fascicles can be selectively activated based on electrode position. However, it is not possible to change the position of the nerve cuff without additional surgery if placed in a suboptimal location.</p><p><strong>Methods: </strong>In this work, we propose the development of a device for closed-loop endovascular VNS that helps mitigate the challenges highlighted earlier and demonstrate this in a preclinical model on 4 subjects. In this minimally invasive procedure, a resheathable stent form factor is deployed within the jugular vein, providing an opportunity for intraprocedural trialing.</p><p><strong>Results: </strong>We demonstrate accurate detection of nerve activation via endovascular evoked compound action potential along with an indication of the specific fibers being activated. Furthermore, this procedure also offers an opportunity to reduce side effects including muscle activation that is seen in current VNS procedures by tuning the applied stimulation.</p><p><strong>Conclusion: </strong>This closed-loop endovascular VNS stimulation platform technology opens up a new paradigm for ongoing research in peripheral nerve stimulation, affecting several disease states.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1221-1230"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146142759","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":"Posterior Facet Distraction and Fusion Technique: Driving a Paradigm Shift in the Surgical Algorithm for Atlantoaxial Dislocation.","authors":"Yue-Qi Du, Boyan Zhang, Tianyu Jin, Hongfeng Meng, Maoyang Qi, Penghao Liu, Jian Guan, Fengzeng Jian, Wanru Duan, Zan Chen","doi":"10.1227/neu.0000000000004007","DOIUrl":"10.1227/neu.0000000000004007","url":null,"abstract":"<p><strong>Background and objectives: </strong>Atlantoaxial dislocation (AAD) remains one of the most technically challenging disorders of the craniovertebral junction. Traditional combined anterior-posterior approaches, although effective, carry substantial morbidity. The posterior facet distraction and fusion (PFDF) technique achieves reduction through sequential facet release and distraction, offering a safer posterior-only alternative. This single-center retrospective study aimed to evaluate the reduction efficacy, clinical outcomes, and safety of a PFDF-centered surgical strategy, and to develop and validate a PFDF-based treatment algorithm for AAD.</p><p><strong>Methods: </strong>From 2017 to 2024, a total of 434 patients with AAD were surgically treated following a PFDF-based algorithm. Based on preoperative imaging, patients were classified as distractable or nondistractable according to the atlantoaxial joint condition. PFDF was performed in distractable patients without vertebral artery contraindications. Combined posterior-anterior approaches were used for patients with contraindicated vertebral artery or inadequate reduction after PFDF. Patients with rigid fusion underwent transoral odontoidectomy for ventral decompression. Clinical and radiological outcomes, complications, and fusion status were analyzed.</p><p><strong>Results: </strong>According to the algorithm, a total of 399 patients (91.9%) achieved satisfactory reduction and decompression using PFDF alone, 12 (2.8%) required posterior fixation with anterior decompression, and 23 (5.3%) underwent transoral odontoidectomy. Significant postoperative improvement was observed in neurological and radiological outcomes ( P < .001). Anatomic reduction was achieved in 90.9% of PFDF patients, with complete bone fusion in all patients within 12 months. The overall complication rate was 5.1%, and no perioperative mortality occurred.</p><p><strong>Conclusion: </strong>The PFDF technique provides a safe, effective, and standardized posterior approach for the management of AAD. By achieving reduction through sequential joint release and distraction, PFDF achieves high reduction and fusion rates while minimizing surgical morbidity. This method simplifies the treatment algorithm for AAD, allowing most patients to avoid anterior surgery and its associated complications.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1180-1189"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147609330","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":"Comparative Effectiveness of Surgery, Embolization, and Radiosurgery for Intramedullary Glomus Arteriovenous Malformations: A Systematic Review and Meta-Analysis.","authors":"Nathan J Bekelman, Abdul Karim Ghaith, Taha Khalilullah, Lansaol Yang, Arman Momeni, Anthony A Davidson, Nicholas Theodore, Risheng Xu, Daniel Lubelski","doi":"10.1227/neu.0000000000003975","DOIUrl":"10.1227/neu.0000000000003975","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spinal glomus arteriovenous malformations are rare intramedullary vascular lesions that can cause progressive myelopathy. Treatment strategies include microsurgical resection, endovascular embolization, and stereotactic radiosurgery. However, comparative effectiveness data remain limited, and previous meta-analyses are outdated. This study systematically compares the clinical and radiographic outcomes of surgery, embolization, and radiosurgery in the treatment of spinal glomus arteriovenous malformations.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Four electronic databases were searched for English-language reports with ≥3 patients and intervention-specific outcome data. Pooled proportions were calculated using random-effects models for 4 endpoints: (1) complete nidus obliteration, (2) partial obliteration, (3) neurologic symptom improvement, and (4) treatment-related complications. Subgroup analyses compared surgery with vs without preoperative embolization. Meta-regression evaluated temporal trends in treatment efficacy.</p><p><strong>Results: </strong>Thirty-six studies comprising 462 patients were included. Patients underwent surgery (51%), embolization (35%), or radiosurgery (14%). Complete obliteration was most likely to occur after surgery (77%), compared with embolization (39%) and radiosurgery (16%) ( P < .001). No significant differences were found between treatment modalities in partial obliteration ( P = .19), symptom improvement ( P = .94), or complication rates ( P = .35). Among surgical patients, preoperative embolization did not affect the rate of complete obliteration ( P = .55). Meta-regression demonstrated an increase in complete obliteration rates after embolization over time.</p><p><strong>Conclusion: </strong>A surgical strategy (resection ± preoperative embolization) yielded the highest obliteration rate in selected, typically compact lesions, without an increased risk of complications compared with embolization or radiosurgery. These rates, particularly for radiosurgery, may increase with longer follow-up lengths. Improvements in embolization techniques over time suggest a growing role for endovascular therapy, particularly as an adjunct to surgery. However, heterogeneity in lesion classification limits the ability to draw definitive treatment recommendations. Standardized diagnostic and outcome reporting frameworks are needed to guide future studies.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1190-1202"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365760","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":"Moving Beyond Packing Density: A Modern Reappraisal of Recurrence and Retreatment in Coiled Aneurysms.","authors":"Patrick S Barhouse, Naveen Arunachalam Sakthiyendran, Shashvat Purohit, Felipe Ramirez-Velandia, Omar Alwakaa, Christopher S Ogilvy, Philipp Taussky","doi":"10.1227/neu.0000000000003945","DOIUrl":"10.1227/neu.0000000000003945","url":null,"abstract":"<p><strong>Background and objectives: </strong>Despite advances in treatment for intracranial aneurysms, recurrence remains a clinical challenge. Studies have suggested associations between treatment modality, aneurysm morphology, and recanalization risk, but comprehensive evaluation of these factors and their relationships is limited. The goal of this study was to evaluate the role of aneurysm location and packing density (PD) as predictors for recurrence.</p><p><strong>Methods: </strong>This is a retrospective cohort study where records of patients who underwent coiling for intracranial aneurysms from 2013 to 2023 from a single institution were reviewed. Recurrence was defined as worsening of angiographic aneurysm occlusion status. Demographics, aneurysm characteristics, clinical outcomes, and follow-up data were recorded. Analysis was performed in RStudio.</p><p><strong>Results: </strong>A total of 505 were included; 195 aneurysms were ruptured (38.6%). The most frequent locations were anterior communicating artery (163), internal carotid artery (85), basilar (76), posterior communicating artery (63), and middle cerebral artery (43). Mean PD was 23.3%, with 109 recurrences (21.6%) and 76 retreatments (15.1%); 31 patients (6.1%) experienced thromboembolic complications. In multivariable analysis, incomplete occlusion (Raymond-Roy [RR] Grades II-III), presence of an incorporated branch vessel, and higher size ratio independently predicted recurrence, whereas male sex and age older than 75 years were protective. Size ratio also predicted retreatment, while stent-assisted coiling reduced the likelihood of retreatment. Although higher PD was associated with better immediate RR Grade, PD (including extremes <15% vs >30%), aneurysm volume, and anatomical location were not independently associated with recurrence or retreatment after adjustment.</p><p><strong>Conclusion: </strong>In this modern series, the immediate RR Grade, not PD or anatomical site, drove long-term durability; PD improved the index occlusion but had no independent association with recurrence after adjustment. Incorporated perforators independently increased recurrence risk, and stent assistance reduced retreatment. These data reframe technical priorities toward achieving complete occlusion safely, especially in perforator-bearing lesions, rather than chasing PD thresholds alone in the contemporary era.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1068-1078"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146106580","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 Safety and Efficacy of Laser Interstitial Thermal Therapy for Newly Diagnosed Deep-Seated Low-Grade Glioma: A Pilot Study Comparing Outcomes With a Surgical Cohort.","authors":"Khushi H Shah, Adham M Khalafallah, Maxon V Knott, Vratko Himic, Jay S Chandar, Vaidya Govindarajan, Victor M Lu, Michael E Ivan, Ricardo J Komotar, Ashish H Shah","doi":"10.1227/neu.0000000000003951","DOIUrl":"10.1227/neu.0000000000003951","url":null,"abstract":"<p><strong>Background and objectives: </strong>Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive alternative to open craniotomy for patients deemed unsuitable for surgery due to deep-seated or eloquent lesion location, age, frailty, or comorbidities. However, its use in newly diagnosed deep-seated low-grade glioma (nLGG) has not been elucidated. We aimed to evaluate the safety and efficacy of LITT for deep-seated nLGG compared with a similar surgical cohort.</p><p><strong>Methods: </strong>We retrospectively reviewed patients with unifocal, deep-seated nLGG treated with either LITT or surgical resection between 2013 and 2024. Demographic, perioperative, and follow-up data were compared between groups. Kaplan-Meier assessed progression-free and overall survival outcomes. To address baseline tumor volume differences, a subset analysis was performed using a greedy nearest-neighbor algorithm to generate a 1:1 matched cohort based on tumor volume.</p><p><strong>Results: </strong>A total of 15 patients in the study group (median age 46 [IQR: 34-53] years, 40.0% men) were compared with 51 patients (median age 38 [IQR: 29-54] years, 43.1% men) in the control group. There were no significant differences in in-hospital complications ( P = .999), 30-day complications ( P = .999), or complications between 30 days and 3 months ( P = .713), new postoperative motor or speech deficits (0.999) between groups. Postoperative adjuvant chemotherapy (23.1% vs 46.9%, P = .217) and radiation (23.1% vs 44.7%, P = .210) rates did not differ significantly. Among high-risk patients, time to adjuvant chemotherapy (64.7 vs 77.7 days) and radiation (36.0 vs 53.6 days) was earlier in the LITT group, although not statistically significant. Kaplan-Meier analysis showed no statistically significant differences in progression-free survival or overall survival between groups. On matched pair analysis, there remained to be no statistically significant differences in outcomes observed between LITT and craniotomy groups.</p><p><strong>Conclusion: </strong>This pilot study is the first to suggest that LITT is a safe treatment option for patients with deep-seated nLGG, offering comparable outcomes with surgical resection.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1079-1091"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125936","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":"Expectation Versus Reality: Exploring Decisional Regret in Minimally Invasive Lumbar Spine Surgery.","authors":"Michael Jeffko, Aiyush Bansal, Kenneth T Nguyen, Kiumars Edalati, Patricia Lipson, Renzo Laynes, Kento Yamanouchi, Jack Sedwick, Maxey Cherel, Laura Reynolds, Philip K Louie","doi":"10.1227/neu.0000000000003946","DOIUrl":"10.1227/neu.0000000000003946","url":null,"abstract":"<p><strong>Background and objectives: </strong>Unrealistic or unmet expectations can contribute to lower satisfaction and decisional regret (DR), particularly as shared decision-making becomes more central in elective spine care. Understanding these dynamics in minimally invasive lumbar decompression may guide strategies to optimize preoperative counseling and patient-centered outcomes. Our study aims to evaluate the correlation between patient expectation-actuality differences and DR following minimally invasive lumbar decompression surgery and to identify other patient-reported outcomes associated with DR.</p><p><strong>Methods: </strong>This prospective cohort study included adults undergoing elective one-level or two-level minimally invasive lumbar decompression. Patients completed preoperative Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) expectation surveys and postoperative MODEMS actuality surveys at 3 and 6 months, along with the Decisional Regret Scale at both time points. Expectation-outcome mismatch was calculated for each MODEMS domain. Predictors of DR were assessed using univariate linear regression, with significance set at P < .05.</p><p><strong>Results: </strong>Among 104 patients (mean age 64.9 years, 54.5% male), 60% reported no regret and 11% high regret at 3 months, compared with 61% no regret and 6% high regret at 6 months. Across both time points, DR was strongly associated with greater expectation-outcome mismatch. In univariate regression, mismatch in pain relief, daily activity, exercise, sleep, return-to-work, and disability prevention significantly predicted higher regret, with pain relief showing the largest effect. Demographic and clinical factors, including age, sex, comorbidity burden, and preoperative disability, were not associated with regret. MODEMS mismatch remained the most consistent predictor at both follow-ups.</p><p><strong>Conclusion: </strong>DR in minimally invasive lumbar decompression is strongly linked to expectation-actuality differences and reduced satisfaction, with pain relief, activity, and exercise emerging as key drivers. These findings highlight the importance of refining tools to assess expectations and identify unmet needs to reduce regret and improve patient-reported outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1020-1027"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118887","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":"T2-Weighted MRI Signal Intensity Ratio Predicts Intraoperative Intracranial Meningioma Consistency: A Retrospective Cohort Study.","authors":"Ishan Shah, David Gomez, Kevin G Liu, David J Cote, Robert G Briggs, Benjamin Fixman, Bryce D Beutler, Apurva Prasad, Jonathan Sisti, Reza Assadsangabi, Gabriel Zada","doi":"10.1227/neu.0000000000003956","DOIUrl":"10.1227/neu.0000000000003956","url":null,"abstract":"<p><strong>Background and objectives: </strong>Meningioma consistency is linked to important clinical and surgical outcomes, and preoperative knowledge of consistency may have significant implications for operative planning and decision making. This study aimed to determine whether intraoperative meningioma consistency is associated with preoperative T2-weighted imaging (T2WI) and diffusion-weighted imaging.</p><p><strong>Methods: </strong>Tumor consistency was prospectively assigned in 188 meningioma patients at the time of surgery over a twelve-year period (2012-2024) using a 5-point scale with validated interuser reliability. Signal intensity was quantified as the intensity ratio between region of interest in the meningioma and the middle cerebellar peduncle using a previously validated methodology (tumor/cerebellar peduncle T2WI intensity [TCTI] ratios). Mean and maximum signal intensity were measured using T2 and diffusion-weighted MRI sequences.</p><p><strong>Results: </strong>When using mean T2WI measurements, TCTI ratios were lower for grade 4 + 5 tumors (1.41 ± 0.31, 95% CI: -0.418 to -0.182, P < .001) compared with consistency grade 3 tumors (1.71 ± 0.32, reference group) and grade 1 + 2 tumors (1.98 ± 0.36, 95% CI: -0.453 to -0.074, P < .004). A similar trend was observed using max region of interest measurements. No association was found between consistency and diffusion-weighted imaging. TCTI ratios using mean (odds ratio: 0.031, 95% CI: 0.009 to 0.101, P < .001) and max (odds ratio: 0.027, 95% CI: 0.007 to 0.097, P < .001) measurements were independent predictors of consistency when adjusting for covariates. In an receiver operating characteristic analysis comparing T2 mean ratios for grade 1 + 2 to 4 + 5 tumors, the area under the curve was 0.868 and precision-recall area under the curve was 0.960. A TCTI ratio cutoff of 1.536 was 75.0% sensitive and 100% specific in differentiating grade 1 + 2 and grade 4 + 5 tumors using T2WI alone.</p><p><strong>Conclusion: </strong>In meningiomas, the TCTI ratio is associated with intraoperative tumor consistency, with higher signal intensity ratios predicting softer meningioma consistency. Application in this manner may augment surgical planning and improve preoperative patient counseling.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1059-1067"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146166110","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: Surgical Versus Medical Management for Severe Pediatric Traumatic Brain Injury: A Systematic Review and Meta-Analysis.","authors":"Nasser M F El-Ghandour","doi":"10.1227/neu.0000000000004008","DOIUrl":"10.1227/neu.0000000000004008","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"e57-e58"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147486818","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":"Electric-Scooters: An Emerging Source of High-Severity Pediatric Head Trauma.","authors":"Pierre Petitet, Alessandra Musarra, Camilla de Laurentis, Pierre-Aurélien Beuriat, Alexandru Szathmari, Matthieu Vinchon, Sofia Guernouche, Etienne Javouhey, Federico Di Rocco","doi":"10.1227/neu.0000000000004153","DOIUrl":"10.1227/neu.0000000000004153","url":null,"abstract":"<p><strong>Background and objectives: </strong>Electric scooters (ES) have become increasingly popular among children and adolescents in France. To date, very little is known about their impact on the incidence and severity of pediatric head trauma (HT).</p><p><strong>Methods: </strong>We conducted a retrospective single-center study of patients aged 2 to 18 years admitted to a pediatric neurosurgery ward between 2021 and 2025 for HT related to ES, nonmotorized two-wheeled vehicles (bicycles, kick-scooters; NMTV), or motorbikes. Demographics, accident characteristics, helmet use, clinical and radiological severity, neurosurgical management, hospital course, and need for rehabilitation were collected. Injury severity was assessed using a multivariate model combining neurological, radiological, and in-hospital outcomes. A follow-up phone interview was conducted in a subset of ES patients to assess long-term functional outcome and postinjury behavior regarding mobility habits.</p><p><strong>Results: </strong>ES-related HT rose from 1 case in 2021 to 25 in 2025, whereas the number of HT related to NMTV and motorbikes remained stable. Nearly half of injured ES riders were below the legal age, and helmet use was rare. The severity profile of ES-related HT was greater than that of bicycle and kick-scooter accidents, and comparable to that of motorbike accidents. Five ES patients required surgical intervention, most commonly for epidural hematoma evacuation. At follow-up, most patients had favorable functional outcomes, but nearly one-third experienced persistent disability, and helmet adoption after injury remained limited.</p><p><strong>Conclusion: </strong>ES have emerged as a high-severity mechanism of pediatric HT, comparable to motorbikes. Enhanced prevention strategies, including helmet enforcement, and age regulation, are urgently needed.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":"1028-1037"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13645400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148369432","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}