Neurosurgery最新文献

{"title":"Hurting More Than Helping? Decompressive Craniectomy in Patients With Symptomatic Intracerebral Hemorrhage After Mechanical Thrombectomy in Acute Ischemic Stroke: Insights From Stroke Thrombectomy and Aneurysm Registry.","authors":"Elliot Pressman, Kunal Vakharia, Waldo R Guerrero, Mohammad-Mahdi Sowlat, Samantha Schimmel, Ilko Maier, Ansaar Raai, Pascal Jabbour, Joon-Tae Kim, Jonathan A Grossberg, Ali Alawieh, Stacey Q Wolfe, Robert M Stark, Marios-Nikos Psychogios, Edgar A Samaniego, Nitin Goyal, Justin Dye, Ali Alaraj, Shinichi Yoshimura, Mohamad Ezzeldin, David Fiorella, Omar Tanweer, Daniele G Romano, Pedro Navia, Hugo Cuellar, Isabel Fragata, Adam Polifka, Justin Mascitelli, Joshua Osbun, Fazeel Siddiqui, Mark Moss, Kaustubh Limaye, Charles Matouk, Min S Park, Waleed Brinjikji, Ergun Daglioglu, Richard Williamson, David J Altschul, Christopher S Ogilvy, Roberto Crosa, Michael R Levitt, Benjamin Gory, Ramesh Grandhi, Alexandra R Paul, Peter Kan, Walter Casagrande, Shakeel Chowdhry, Michael F Stiefel, Alejandro M Spiotta, Maxim Mokin","doi":"10.1227/neu.0000000000003563","DOIUrl":"https://doi.org/10.1227/neu.0000000000003563","url":null,"abstract":"<p><strong>Background and objectives: </strong>It remains unclear whether decompressive craniectomy (DC) is beneficial in patients who suffer symptomatic intracerebral hemorrhage (sICH) after acute ischemic stroke (AIS). We sought to study the effect of DC on functional outcomes in patients with sICH after AIS who underwent mechanical thrombectomy (MT).</p><p><strong>Methods: </strong>Patients with AIS from anterior circulation large vessel occlusion who underwent MT and subsequently developed sICH were identified from the Stroke Thrombectomy and Aneurysm Registry database. The primary outcome was acceptable 90-day functional neurological outcome, defined as modified Rankin scale (mRS) 0-3. Multivariable logistic regression and propensity-score matching were used to identify and quantify risk factors.</p><p><strong>Results: </strong>Of 464 patients identified with sICH after AIS after MT, 97 patients (20.9%) underwent DC. Patients who underwent DC were more likely to be female (P < .001), younger (P < .001), have a measured medical comorbidity, have higher baseline mRS (P = .02), and have higher-grade hemorrhages (P = .01). At 90 days, 14% of patients had the primary outcome of mRS 0-3 and 56% had died. The primary outcome was observed in 11 patients who underwent DC (11%) and 55 (15%) of those without DC (odds ratio [OR] 0.7, 95% CI 0.4-1.4, P = .40). DC did not affect mRS shift at 90 days (P = .10) but was associated with lower mortality (OR 0.5, 95% CI 0.3-0.8, P = .01). Multivariable analysis demonstrated that DC decreased the odds of primary outcome (adjusted OR 0.2, 95% CI 0.02-0.9, P = .045), but did not affect mortality (P = .94), mRS shift (P = .50), or length of stay (P = .90). Propensity-matched analysis similarly demonstrated that non-DC patients were more likely to achieve the primary outcome (24% vs 8%, P = .045).</p><p><strong>Conclusion: </strong>In patients with sICH after AIS after MT, those selected for DC had less favorable outcomes and similar rates of mortality at 90 days.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248880","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":"Addressing Limited Generalizability in Artificial Intelligence-Based Brain Aneurysm Detection for Computed Tomography Angiography: Development of an Externally Validated Artificial Intelligence Screening Platform.","authors":"Samuel D Pettersson, Jean Filo, Peter Liaw, Paulina Skrzypkowska, Tomasz Klepinowski, Tomasz Szmuda, Thomas B Fodor, Felipe Ramirez-Velandia, Piotr Zieliński, Yu-Ming Chang, Philipp Taussky, Christopher S Ogilvy","doi":"10.1227/neu.0000000000003549","DOIUrl":"https://doi.org/10.1227/neu.0000000000003549","url":null,"abstract":"<p><strong>Background and objectives: </strong>Brain aneurysm detection models, both in the literature and in industry, continue to lack generalizability during external validation, limiting clinical adoption. This challenge is largely due to extensive exclusion criteria during training data selection. The authors developed the first model to achieve generalizability using novel methodological approaches.</p><p><strong>Methods: </strong>Computed tomography angiography (CTA) scans from 2004 to 2023 at the study institution were used for model training, including untreated unruptured intracranial aneurysms without extensive cerebrovascular disease. External validation used digital subtraction angiography-verified CTAs from an international center, while prospective validation occurred at the internal institution over 9 months. A public web platform was created for further model validation.</p><p><strong>Results: </strong>A total of 2194 CTA scans were used for this study. One thousand five hundred eighty-seven patients and 1920 aneurysms with a mean size of 5.3 ± 3.7 mm were included in the training cohort. The mean age of the patients was 69.7 ± 14.9 years, and 1203 (75.8%) were female. The model achieved a training Dice score of 0.88 and a validation Dice score of 0.76. Prospective internal validation on 304 scans yielded a lesion-level (LL) sensitivity of 82.5% (95% CI: 75.5-87.9) and specificity of 89.6 (95% CI: 84.5-93.2). External validation on 303 scans demonstrated an on-par LL sensitivity and specificity of 83.5% (95% CI: 75.1-89.4) and 92.9% (95% CI: 88.8-95.6), respectively. Radiologist LL sensitivity from the external center was 84.5% (95% CI: 76.2-90.2), and 87.5% of the missed aneurysms were detected by the model.</p><p><strong>Conclusion: </strong>The authors developed the first publicly testable artificial intelligence model for aneurysm detection on CTA scans, demonstrating generalizability and state-of-the-art performance in external validation. The model addresses key limitations of previous efforts and enables broader validation through a web-based platform.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248940","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 Impact of Social Determinants of Health on the Severity of Symptoms at Presentation and Discharge Disposition in Patients Undergoing Surgical Treatment of Cervical Myelopathy.","authors":"Hendrick Francois, Atta Boateng, Carly Weber-Levine, Kelly Jiang, Smruti Mahapatra, A Daniel Davidar, Andrew M Hersh, Safwan Alomari, Sarah Johnson, Meghana Bhimreddy, Kitara Smith, Tej D Azad, Kimberly Ashayeri, Nicholas Theodore","doi":"10.1227/neu.0000000000003557","DOIUrl":"https://doi.org/10.1227/neu.0000000000003557","url":null,"abstract":"<p><strong>Background and objectives: </strong>Social determinants of health (SDOH), such as education, insurance, race, and income, significantly affect a patient's medical care and surgical outcomes. Additional studies characterizing the impact of SDOH on patients undergoing spine surgery are needed. Accordingly, this study evaluates the impact of SDOH on severity of symptoms at presentation and discharge disposition in patients undergoing surgical treatment of cervical myelopathy.</p><p><strong>Methods: </strong>A retrospective single-center study identified adult patients undergoing surgical intervention for cervical myelopathy between 2016 and 2020. Cohort characteristics were collected from patient medical records. The t-test, Wilcoxon rank-sum, analysis of variance, Kruskal-Wallis, and χ2 tests were used to compare variables when appropriate. Multivariable linear and logistic regression analyses were conducted for modified Japanese Orthopaedic Association (mJOA) and discharge disposition. All statistical analysis was performed in MATLAB R2022b (MathWorks, Natick, MA).</p><p><strong>Results: </strong>A total of 480 patients were included in the study with a male predominance of n = 281 (59%) and a mean age of 62 ± 13 years. Racial demographics included 64% White (n = 308) and 36% Non-White (n = 172) patients. On univariable analysis, mJOA at presentation was significantly associated with employment status (P < .01), annual income (P < .01), education level (P < .01), and insurance status (P = .03). On multivariable analysis, annual income and education level continued to be significant predictors of presenting mJOA. On univariable analysis, discharge disposition was associated with body mass index (P = .01), mJOA at presentation (P < .01), employment status (P = .05), annual income (P < .01), education level (P < .01), insurance (P < .01), approach (P < .01), and length of stay (P < .01). On multivariable analysis, mJOA at presentation, education level, insurance, and approach continued to be significant predictors of discharge disposition.</p><p><strong>Conclusion: </strong>SDOH affect the severity of symptoms at presentation and discharge disposition in patients undergoing surgery for cervical myelopathy. Understanding these dynamics and uncovering additional SDOH are critical for enhancing surgical care and achieving equitable healthcare outcomes.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248881","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":"Age and Baseline Disability Inform Tradeoffs in Cost Utility of Adult Spinal Deformity Surgery.","authors":"Tej D Azad, Alessio Pignatelli, Noor Alesawy, Jeffrey L Gum, Peter Passias, Christopher I Shaffrey, Justin Smith, Shay Bess, Richard Hostin, Pratibha Nayak, Alan H Daniels, Bassel Diebo, Eric Klineberg, Hamid Hassanzadeh, Christopher P Ames, Khaled M Kebaish, Amit Jain","doi":"10.1227/neu.0000000000003550","DOIUrl":"https://doi.org/10.1227/neu.0000000000003550","url":null,"abstract":"<p><strong>Background and objectives: </strong>Surgery can be an effective intervention for adult spinal deformity (ASD), but it is expensive and associated with a high complication rate. The aim of this study was to analyze the cost-effectiveness of ASD surgery, with age and baseline (BL) disability as key variables.</p><p><strong>Methods: </strong>Decision-analytic models were constructed to assess 3 treatment strategies: operative, nonoperative, and nonoperative with delayed surgery. Model inputs were derived from prospective registry data and published literature, and modeled stochastically. Equivalent decision trees but with different parameter values were constructed for 6 patient subgroups categorized by age (\"middle-aged\" group: mean age 50 years vs \"elderly\" group: mean age 70 years), and disability level (low: Oswestry Disability Index (ODI) <20, moderate ODI 20-40, high ODI >40). 1000 Monte Carlo simulations of a hypothetical population of 10 000 patients were generated and used to determine cost-effectiveness metrics and their uncertainty.</p><p><strong>Results: </strong>ASD surgery was cost-effective at a $150 000/quality-adjusted life year (QALY) willingness-to-pay threshold for middle-aged groups with moderate disability (incremental cost-effectiveness ratio (ICER) = $91 340/QALY) favored in 60.1% of patients, and high disability (ICER = $66 090/QALY) favored in 69.9% of patients. For elderly patients with high disability (ICER = $154 300/QALY), surgery was favored in 49.7% of patients. For all other groups, the ICER was above $194 000 and surgery was favored in less than 46.3% of patients. Middle-aged patients gained higher incremental QALYs across all disability levels, and operative strategy demonstrated higher cost-utility in middle-aged patients at the same BL disability. One-way deterministic sensitivity analysis revealed probability of failed nonoperative treatment favored surgery, especially in patients with low disability, whereas probability of complicated operative course favored nonoperative treatment, especially in elderly patients.</p><p><strong>Conclusion: </strong>Our analysis revealed that middle-aged patients and those with higher BL disability are more likely to achieve cost-effective surgical intervention. These findings set a basis for further investigation that could better inform clinical decision making for elderly patients experiencing ASD.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248877","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: Laparoscopy Versus Laparotomy for Ventriculoperitoneal Shunt Placement: A Systematic Review and Meta-Analysis.","authors":"Nasser M F El-Ghandour","doi":"10.1227/neu.0000000000003562","DOIUrl":"https://doi.org/10.1227/neu.0000000000003562","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248879","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 Treatment of Spontaneous Intracranial Hypotension From Spinal CSF Leak: Single Institution Case Series.","authors":"Catherine M Garcia, Wouter I Schievink, Julie L Chan","doi":"10.1227/neu.0000000000003561","DOIUrl":"https://doi.org/10.1227/neu.0000000000003561","url":null,"abstract":"","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234648","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 Use of Intraoperative Neuromonitoring in Routine Percutaneous Spinal Cord Stimulator Surgery is Not Associated With Improved Placement, Patient Safety, or Pain Severity Outcomes.","authors":"Jordan Black, Ishan Singhal, Jennifer E Murphy, Michael D Staudt","doi":"10.1227/neu.0000000000003547","DOIUrl":"https://doi.org/10.1227/neu.0000000000003547","url":null,"abstract":"<p><strong>Background and objectives: </strong>The placement of spinal cord stimulators (SCSs) relies on midline placement to provide bilateral coverage. Implantation under general anesthesia using intraoperative neuromonitoring (IOM) has been shown to be a valid alternative to awake placement to confirm positioning. It has been suggested that placement should be confirmed with awake testing or IOM for reasons of efficacy and safety. No study has compared operative outcomes in percutaneous SCS surgery with our without the use of IOM.</p><p><strong>Methods: </strong>A single-center retrospective chart review was performed, identifying 228 patients who underwent percutaneous SCS implantation between 2021 and 2023 by a single surgeon. Surgery was performed with IOM (n = 55) or without IOM (n = 173). The primary outcome measures were laterality of coverage, revision and explant rates, and incidence of intraoperative complications. Secondary outcomes included pain severity scores (Numerical Rating Scale) and operative duration.</p><p><strong>Results: </strong>All patients had bilateral stimulation coverage regardless of IOM, and no revisions for laterality occurred. Revision rates for fracture of migration did not significantly vary between cohorts (IOM 3.6%, non-IOM 4.0%; P > .999). Explantation rates were also not significantly different (IOM 9.1%, non-IOM 5.2%; P = .334). Patients in both cohorts demonstrated a lower Numerical Rating Scale at last follow-up compared with baseline; however, this change did not significantly vary between cohorts (IOM 4.7 vs non-IOM 4.4; mean difference: 0.26; P = .713) nor did the proportion of responders (IOM 52.6% vs non-IOM 48.9%; P = .684). Operative duration was significantly longer in the IOM cohort (65.3 vs 48.6 minutes; mean difference: 16.5 minutes; P < .001), as was \"room-to-incision\" time (41.0 vs 33.3 minutes; mean difference 7.66 minutes; P < .001). No intraoperative complications were encountered in either cohort, including no nerve irritation or neurological injury.</p><p><strong>Conclusion: </strong>Percutaneous SCS placement can safely and accurately be performed without the use of IOM. IOM does not improve placement accuracy or laterality of coverage, as long as leads are placed anatomically in the midline.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234651","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":"Single-Fraction Stereotactic Radiosurgery as Primary Management of Sporadic Meningiomas: A 25-Year Cohort Study.","authors":"Rahul Kumar, Lucas P Carlstrom, Ramin Morshed, Paul D Brown, Nadia N Laack, Anita Mahajan, Christopher S Graffeo, Michael J Link, Bruce E Pollock","doi":"10.1227/neu.0000000000003528","DOIUrl":"https://doi.org/10.1227/neu.0000000000003528","url":null,"abstract":"<p><strong>Background and objectives: </strong>Stereotactic radiosurgery (SRS) is increasingly used as a primary treatment modality for intracranial meningiomas. We aim to describe clinical outcomes after single-fraction SRS for sporadic intracranial meningiomas.</p><p><strong>Methods: </strong>A prospectively maintained database was reviewed for patients with sporadic meningiomas who underwent SRS (Gamma Knife) as primary treatment modality from April 1997 to February 2022. Primary outcomes included progression-free survival (PFS) and treatment-related complications.</p><p><strong>Results: </strong>Six hundred sixteen patients (653 tumors) underwent SRS with median follow-up of 6.3 years (interquartile range [IQR] 3.1-10.5 years). The median tumor volume was 4.5 cm3 (IQR 2.0-8.0 cm3). The median margin dose was 15.0 Gy (IQR 14.0-16.0). In-field progression was noted in 7 tumors (1.1%) and marginal progression in 2 tumors (0.3%) for a raw failure rate of 1.4%. PFS estimates at 5, 10, and 15 years were 99.8%, 99.0%, and 93.2%, respectively. Factors associated with reduced PFS on univariable analysis included older age (hazards ratio [HR] 1.14, 95% CI, 1.05-1.22, P < .001), male sex (HR 5.44, 95% CI, 1.45-20.4, P = .010), increasing tumor volume (HR 1.06, 95% CI, 0.99-1.13, P = .028), and lower tumor margin dose (HR 0.65, 95% CI, 0.43-0.97, P = .006). Treatment-related complications were noted in 56 patients (9.1%), of which 45 (7.3%) were temporary, 5 (0.8%) were minor, and 6 (1.0%) were permanent and/or required intervention. Radiosurgical parameters associated with treatment-related complications included increased number of isocenters (odds ratio [OR] 1.09, 95% CI, 1.04-1.14, P < .001), higher 12-Gy volume (OR 1.06, 95% CI, 1.03-1.09, P < .001), larger tumor volume (OR 1.06, 95% CI, 1.02-1.10, P < .001), and lower maximal dose (OR 0.90, 95% CI, 0.82-0.98, P = .11).</p><p><strong>Conclusion: </strong>SRS is effective as a primary treatment modality for sporadic, small-volume to medium-volume intracranial meningiomas. Pre-emptive SRS should be discussed as a safe management strategy compared with observation alone for incidentally discovered meningiomas.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234649","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":"Surgical Treatment of Spontaneous Intracranial Hypotension From Spinal Cerebrospinal Fluid Leak: Single Institution Case Series.","authors":"Ryan Gensler, Alan Balu, Amanda Kraus, Parker Buck, Jean-Paul Bryant, Kelsey Cobourn, Gnel Pivazyan, Anousheh Sayah, Vinay Deshmukh","doi":"10.1227/neu.0000000000003543","DOIUrl":"https://doi.org/10.1227/neu.0000000000003543","url":null,"abstract":"<p><strong>Background and objectives: </strong>Spontaneous intracranial hypotension (SIH) is a rare but debilitating condition caused by spontaneous spinal cerebrospinal fluid (CSF) leaks, resulting in low intracranial pressure. Patients with SIH often experience orthostatic headaches, nausea, dizziness, visual and auditory changes, and cognitive impairment. While initial treatment includes oral analgesics, rest, and epidural blood patching, refractory cases may require advanced diagnostics and surgical intervention to repair the CSF leak. The aim of this study was to review the characteristics and outcomes of patients with refractory SIH who underwent surgical repair for spontaneous spinal CSF leaks.</p><p><strong>Methods: </strong>This retrospective, Institutional Review Board-approved (STUDY00007663), single-institution study reviewed patients with SIH because of spontaneous spinal CSF leaks who underwent surgery by a single surgeon from September 2022 to June 2024. Demographics, clinical symptoms, diagnostics, and outcomes were collected through chart review. Preoperative and postoperative Bern scores, derived from brain MRIs, were evaluated by a neuroradiologist.</p><p><strong>Results: </strong>Among 138 patients diagnosed with SIH, 50 refractory to conservative management underwent surgical repair. The surgical cohort had an average age of 52.1 ± 13.9 years, with 64% female. Presenting symptoms included headaches (92%), pain/numbness (46%), and nausea/vomiting (46%). CSF leak classifications were Type I (38%), Type II (10%), and Type III (52%). Postsurgery, 96% achieved significant symptom resolution or improvement, with notable reductions in headache frequency (P < .01), Bern scores (P < .01), and Visual Analog Scale scores (P < .01).</p><p><strong>Conclusion: </strong>Surgical repair is crucial for managing refractory SIH, with tailored techniques based on leak type and location. This study underscores the need for further research into the predictive utility of Bern scores in surgical outcomes across various CSF leak types.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234650","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 Guideline on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas: Update.","authors":"Jamie J Van Gompel, Lucas P Carlstrom, Constantinos G Hadjipanayis, Christopher S Graffeo, Neil Patel, Matthew L Carlson, Jeffrey Jacob, Jeffrey J Olson","doi":"10.1227/neu.0000000000003473","DOIUrl":"https://doi.org/10.1227/neu.0000000000003473","url":null,"abstract":"<p><strong>Background: </strong>Surgical intervention remains an important option in the management of vestibular schwannoma (VSs). Development of a systematic approach to choose the most appropriate route for this intervention, based on existing published evidence, is an important goal.</p><p><strong>Objective: </strong>To review the literature published since the 2018 Congress of Neurological Surgeons Guideline on surgical intervention for patients with sporadic VSs and use this information to update that set of recommendations.</p><p><strong>Methods: </strong>The literature in the PubMed and MEDLINE databases from January 2015 through May 20, 2022, was searched for manuscripts pertaining to surgical intervention for VSs. Those manuscripts meeting inclusion criteria were then analyzed for creation of recommendations in response to a set of updated questions.</p><p><strong>Results: </strong>The resultant findings included a considerable amount of data that did not alter the recommendations form the 2018 publication on this topic. Thus, recommendations stating hearing preservation surgery through the middle fossa or retrosigmoid approach may be considered in individuals with good preoperative hearing as an alternative to simple observation remain. In addition, if microsurgical resection is necessary after stereotactic radiosurgery, it is recommended that patients be counseled that there is an increased likelihood of a subtotal resection and decreased facial nerve function. In some questions, insufficient data were present to create an answer and that is stated.</p><p><strong>Conclusion: </strong>This guideline demonstrates surgical intervention for VSs and represents a range of options, and the choice of the intervention depends on the specific aspects of the lesion and the individual that harbors them. Objective refinement of those choices will require thoughtful research design by investigations that wish to address those items for which we still have insufficient information.</p>","PeriodicalId":19276,"journal":{"name":"Neurosurgery","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144226076","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}